Please send the completed form along with payment to:

Licking Memorial Health Foundation1320 West Main StreetNewark, Ohio 43055

If you would like to pay by credit card, please call the Development Office at (220) 564-4102.

To ensure that Licking Memorial Hospital may continue to offer quality health care for future generations, gifts received through the Cradle Roll Program will benefit technological advances and capital improvements at LMH and assist with our mission to improve the health of the community. Gifts are tax-deductible to the extent allowed by law.

Cradle Roll Program

1955-502903/30/2021LMHealth.org

Licking Memorial Hospital

If you would like to honor a special baby with this unique gift, please complete the form, and return it with your payment to the address listed.

Donation FormEnclosed is my gift of $

This will designate the gift as: (check one) Cradle Roll (up to $24.99) Cradle Roll Bronze ($25 to $149) Cradle Roll Silver ($150 to $249) Cradle Roll Gold ($250 or more)

My gift is eligible for: (check one) Step-up Stool ($150 to $249) Rocker ($250 or more)

I would like the step-up stool/rocker to be: (check one) Cherry Finish Oak Finish

Please call me at ( ) - to arrange a pick-up time when my furniture is ready.

The baby’s name should be listed as:

The baby’s date of birth is:

I would like a letter of acknowledgment of my gift sent to:

Name:

Relationship to baby:

Mailing address:

City State Zip

Donor’s name:

Relationship to baby:

Donor’s mailing address:

City State Zip

Email:

The Cradle Roll Program at Licking Memorial Hospital (LMH) is a unique opportunity for parents, grandparents, family members and friends to celebrate and commemorate the arrival of a new baby. With a gift of any amount, the name of the baby and the donor will be placed in the Cradle Roll Log located in the Hospital Main Lobby. This information also will be listed in the Community Connection magazine and Licking Memorial Health Systems Annual Report. Receipt of your contribution will be immediately confirmed by mail, and a letter of acknowledgment will be promptly sent to the honoree’s family.

Cradle Roll BronzeGifts of $25 to $149 will be designated as Cradle Roll Bronze.

Cradle Roll SilverBabies honored with a gift of $150 to $249 will receive a beautiful, handcrafted step-up stool in your choice of two finishes.

Cradle Roll GoldBabies honored with a gift of $250 or more will receive a striking, handcrafted child-size rocker in your choice of two finishes.

Handcrafted child-size rocker(Shown with oak finish)

Handcrafted step-up stool(Shown with cherry finish)

Your New Family Joining Ours