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Amputee Bears Sign Up

Please complete the online submission form to be considered for a custom Amputee Teddy Bear for your wounded warrior family. If requesting more than 1 (example 2 children in household) please submit this form twice, 1 for each child. Thank you. For questions email info@operationward57.org

Contact Information

Service Members/Veterans Name

First Name

Last Name

Child's Name

First Name

Last Name

Verify Email

Shipping Address

Address Line 1

Address Line 2

City

State/Province

ZIP/Postal Code

Country

Phone Number

Example: 212-555-1212

Military Branch

Amputation Requested

Please select the specific type and number of amputations. Click all the apply.

1 Arm Amputation Left

1 Arm Amputation Right

2 Arm Amputation

1 Leg Amputation Left

1 Leg Amputation Right

2 Leg Amputation

All 4 Limbs

Name on Nametag

Character space is limited so please keep to 1 Name:. Example: Robinson If no nametag requested please specify "none"

Special Requests:

Send us a note if you have any special requests. We will do our best to accommodate them.

Would you like us to use a uniform you send in?

We are happy to make the bear out of one of your wounded warriors uniforms. Just click Yes and we will contact you with a shipping address. Otherwise, click No and we will use a donated uniform to complete your bear.

Yes