Enter to Win a Wii Console & Wii Fit Bundle

Please note: the Pediatric Emergency Department has moved to an expanded, more convenient location across from the Adult Emergency Department near the Emergency entrance (just down the hall from the former location). The new space offers a larger waiting area and more privacy and comfort for our young patients and their families, with the same great care! Clear directional signage is posted.

Simply complete the information below and enter for your chance to win. One entry per household. Must be 18 or older to enter.

	Name*

	Date of Birth
	mm/dd/yyyy

Address*

Street Number
City
State
Zip Code

	Home Phone

	E-mail Address*

What age range does your child/children fall into*

None

5 or younger

6 to 11

12 to 20

	Please send me information on Hillcrest Hospital's Pediatric ED, Pediatric Unit and health information for children.*
	YesNo