Bear Sign-up (Live)

Fill out the form below for your order to be placed on the list. Molly Bears will NOT share or sell your information! (*) Fields are required.

Your First Name(*)
Please let us know your first name.

Your Last Name(*)
Please let us know your last name.

Your Email(*)
Please let us know your email address.

Your Phone(*)
Please let us know your phone number.

Your Address(*)
Please let us know your address.

Your City(*)
Please let us know your city.

State / Providence
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Other State or Providence(*)
Please let us know your state or providence.

Your Zip or Postal Code(*)
Please let us know your zip or postal code.

Your Country
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Angel's Name
Please let us know your angels name.

Angel's Birthday

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Angelversary Date

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Angel's Gender
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Angels Birth Weight (Pounds)(*)
Please enter a whole number in pounds only. No decimals or commas allowed.

Angels Birth Weight (Ounces)(*)
Please enter a whole number in ounces only. No decimals or commas allowed.

No Weight
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Special Instructions
Please let us know your message.

(Limit 500 Characters)
Please list any colors, items or any other information which reminds you of your angel. For example, sailboats, angels, lambs, butterflies..etc. We will use these details to personalize the decorations on your bear. *Please note, the special requests are simply that, requests. We will make every effort to fulfill as many requests as possible.

Plain Bear, NO DECORATIONS
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International
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Are You The Parent(*)
You must be the parent of an angel to submit a Molly Bear order.

If you are not the parent of this child, please exit this form at this time. We are only able to process orders placed by the parent of the angel.

Age Restriction(*)
You must be the parent of an angel to submit a Molly Bear order.

If your child was older than 12 months, due to our 501(c)3 status, we are unable to create a Molly Bear for you at this time. You may Contact Us to request referrals to companies that provide services to families that have suffered the loss of an older child.

Non-Refundable Waiting List Fee(*)
You must agree to the Molly Bears Terms of Agreement.

Terms of Agreement(*)
You must agree to the Molly Bears Terms of Agreement.

How to order a Molly Bear

Bear FamilyTo order your very own Molly Bear, we open the order form once a month, on the 30th for a limited number of orders.

You provide all information; child's name, weight, birthdate/angel date, any special requests and other information. Once your order and payment fee of $20 is completed, you will be placed on our waiting list.

We create bears in the order they were received. This is unless you choose to be a part of our opportunity drawings.

Molly Bears runs 100% off of your donations. Each donation made, no matter how big or small, helps us to fill the aching arms of baby-loss families all over the world.

Please be assured, we are working tirelessly to get your bear home and in your arms as quickly as we possibly can.