Client Visit Client Visit If you are human, leave this field blank. Client Information Client First Name * Client Last Name * Volunteer / Staff First Name * Volunteer / Staff Last Name * Date * Radio Buttons Due Date Birth Date Due Date OR Birth Date of Baby * Items Select an item * Baby Carrier (10) Baby Gate (4) Baby Gift Pack (2) Baby Oil LARGE (2) Baby Oil SMALL (1) Bath Tub (6) Bath Tub Chair (5) Bathing Wipes (1) Bib (1) Blanket MEDIUM (crochet/knitted) (3) Blanket QUILT / COMFORTER (4) Blanket RECEIVING (2) Booster Seat (5) Booties (2) Boppy Pillow Cover (2) Boppy Pillow WITH Cover (4) Boppy Pillow W/OUT Cover (3) Bottle LARGE (2) Bottle SMALL (1) Bottle Warmer (3) Bouncy Seat (8) Burp Cloth (1) Car Seat Cover (4) Car Seat Insert (2) Changing Pad (3) Crib Pad / Sheet (3) Cups/Dishes (2) Diaper Bag LARGE (5) Diaper Bag SMALL (3) Diaper Genie (6) Diaper Genie Refill (2) Diaper Holder/Stacker (3) Diapers (2) Diaper Rash Cream (2) Formula LARGE (4) Formula MEDIUM (3) Formula INDV. SERV. (2) Formula MULTI-PACK (3) Formula MINI PACK (1) Hat (1) High Chair (Chair Top) (8) High Chair (Free Standing) (12) Jacket/Coat (2) Johnson Baby Gift Pack (3) Lotion LARGE (2) Lotion SMALL (1) Maternity Clothes/Bra (3) Mobile (5) Mom’s Gift/Hygiene Set (2) Monitor (8) Nursery Lamp (4) Nursing Cover / Drape (3) Nursing Pads (3) Onesies (1) Outfit (1) Pacifier (1 per pkg) (1) Pacifiers (2 per pkg) (2) Pack-n-Play / Porta Crib (14) Play Mat (7) Plug Protectors (Outlet Covers) (3) Powder LARGE (2) Powder SMALL (1) Shampoo LARGE (2) Shampoo SMALL (1) Shoes (2) Sleeper (2) Socks (2 pairs) (1) Spoons (1) Stroller LARGE (14) Stroller UMBRELLA (6) Swaddler (2) Sweater (2) Swing (8) Teether (1) Thermometer (4) Toys LARGE (3) Toys SMALL (1) Towel (2) Towel Set (4) Walker / Exersaucer (8) Wash Cloth (1) Wash Cloths (set of 3) (2) Wipes (over 40ct) (2) Wipes (under 40ct) (1) QTY * Total Points Add Another Item Remove Item Total Points Spent Clients CANNOT spend more than 14 points per shopping appointment! (Unless they’re having twins!) Total Points Spent Today