Shalom Baby Package

Please complete all of the following information (including apartment number, if appropriate) and a Shalom Baby package will be sent anywhere in the greater Chicagoland area to a newborn up to one year old, with a note that you have requested this gift.

*Baby's Complete Name:
Baby's Birth Date: (mm/dd/yyyy)*
*Parents' Complete Names:
*Address 1:
Address 2:
*City:
*State:
*Zip:
Parents' Phone: (123-456-7890)
Parents' Email:
*Your First Name:
*Your Last Name:
Your Phone: (123-456-7890)*
*Your Email:
Please include a big sister certificate for:
Name(s) of Sister(s)
Please include a big brother certificate for:
Name(s) of Brother(s)
How did you learn of Shalom Baby?

* (indicates required field)