Project: Hollywood Cares -Family Request

Wounded Warriors of Operations Iraqi or Enduring Freedom

Larger care packages are sent or personally delivered to seriously wounded servicemen and women rehabilitating in our military hospitals. Appropriate programs and gifts are sent to wounded patients with a hospital stay of at least five weeks remaining from time request in order to insure package delivery before discharge.

Important: Military address information is confidential and Project: Hollywood Cares does not share this information with any other parties.

Wounded Patient Information

	(All fields are required.)

	First Name
	Last Name
	Rank/Rate:
	Branch of Service
	Military Hospital
	Est. Length of Stay
	Room #
	E-mail
	Address 1
	Address 2
	City
	State
	Zip Code
	Additional Information

TV/Music Preference and Favorites:

Person Making Request

	(All fields are required.)

	First Name
	Last Name
	Relationship to Patient
	E-mail
	Address 1
	Address 2
	City
	State
	Zip Code