Thank you for your interest in the Mobile Playroom Program. We look forward to receiving your request and being a part of “lifting the spirits of hospitalized children” at your hospital or healthcare institution.
To request and obtain a Mobile Playroom unit, simply follow the 3 easy steps listed below:
Step 1 – Complete the Mobile Playroom Questionnaire.
The Mobile Playroom Questionnaire can now be completed on-line. Please follow this link to complete the form.
Step 2 – Download and Execute the “Mobile Playroom Terms and Conditions” Agreement.
Please download and print the Agreement and have it signed by an authorized signatory at your facility.*
We cannot process your Agreement unless it contains the numeric code included in your Mobile Playroom Questionnaire Confirmation Email. Please make sure you have submitted the questionnaire before submitting the Agreement.
To download an editable MS WORD Agreement, please click here.
To download a PDF version of the Agreement, please click here.
*Do note that although the MS WORD version can be edited electronically, it will still require a “wet” signature after its printed.
Step 3 – Submit the Executed “Mobile Playroom Terms and Conditions” Agreement.
You can submit the executed Agreement via three easy and convenient methods:
* Direct Upload (please click here)
* Fax: (310) 451-1899
* U.S. Postal Service: 256 26th Street Suite 200, Santa Monica, CA 90402
Once the Questionnaire and Agreement have been received, the Mobile Playroom unit will be prepared and shipped directly to you. Please keep in mind that the Mobile Playroom Program is funded through the kind support of the general public, so it may take The Oscar Litwak Foundation a certain amount of time to collect the funds necessary to underwrite the Mobile Playroom unit. Although not a requirement, if your hospital has the funds to sponsor a unit, this will expedite the process. We will keep you informed as to the status of your unit as much as possible.
