Name *

First Name

Last Name

Phone *

(###)

###

####

Address you want the stork delivered to

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

What gender is baby?

BOY

GIRL

What day was baby born?

MM

DD

YYYY

What day will baby be home?

MM

DD

YYYY

Would you like an accompanying sibling or special message sign? (Star, kitty & dog bone shapes available). $30 each

Note: Please specify the name and gender of siblings and/or pets

Sibling star(s)

Dog bone(s)

Kitty cat(s)

None

I acknowledge signs are not to be moved, taken down or altered by anyone other than Stork On The Rock. If you notice any damage to the stork, please let us know immediately. There will be a replacement fee should a sign be damaged, pending it is not weather related. I acknowledge that Stork On The Rock is not responsible or liable for any and all injuries involving the sign while on the renter's property. In ordering a stork sign, the homeowner accepts responsibility for the sign while on the owner's property. *

I Understand

No

I acknowledge that a secure payment invoice through Square will be sent after confirmation with Stork On The Rock. I understand that payment is required prior to placement of the stork(s). *

Option 1

Option 2