Southeast Regional Center

Movie Request Form

The Daniel M. Soref Family Resource Center offers DVD movies to families with a child receiving inpatient care at Children's Wisconsin located in Milwaukee.

1. Up to three movies per patient room may be checked out at a time.

2. Loan period is three days and may be renewed one time.

3. Movies and games must be returned to the Family Resource Center. After hours use the book returen outside of the Center.

4. If movies are not returned, families will not be able to check out any more until those items are returned or replaced. Replacement cost for movie is $20.

Parent/Guardian Name

Child's Name

Hospital Room #

Please provide up to three titles and barcode numbers of your preferred selections:

1. Title  Barcode Number

2. Title  Barcode Number

3. Title  Barcode Number

Please provide alternative selections, in case your top three are not available:

4. Title  Barcode Number

5. Title  Barcode Number

6. Title  Barcode Number

 

Call Southeast Regional Center at 800-234-KIDS (5437)

Located in the Daniel M. Soref Family Resource Center at Children's Hospital of Wisconsin
8915 W. Connell Court, Milwaukee, WI
Open 9:00 a.m. – 5:00 p.m. Monday – Friday

© Southeast Regional Center 2021
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