Rock’n Rooms Basket Qualifications

Your child must meet the two conditions below to qualify for a Rock’n Rooms Basket.

  • Your child must be a patient at a hospital in the Portland Oregon area.
  • Your child must have an extended hospital stay of three or more weeks.
Rock'n Room Baskets

Request a Basket Form

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Child's First Name*
Child's Last Name*
Child's Age*
Parent/Guardian First Name*
Parent/Guardian Last Name*
Parent/Guardian Phone*
Parent/Guardian Email*
Child's Tending Hospital*
Reason for Hospitalization*
Child's Hospital Check-in Date*
Child's Room Number*

Top Three (3) Themes that your child would like:

Additional Comments IE: Child's Special Needs