Cheer Box Submission Form

The Cheer Box program is an annual event that EveryStep Grief & Loss Services, home of Amanda the Panda, holds to give gifts to grieving families during the holidays. These gifts are wrapped and delivered to the individuals' and families' doorsteps and are meant to lighten the spirits during a time of year that can be tough when a loved one has died.

To submit an individual or family to receive a Cheer Box, please fill out the form below. If you have questions, please contact Megan at If your prefer to print a hard copy, please download this form and email it to, fax to 515-223-4782, or mail it to EveryStep, Grief & Loss Services, home of Amanda the Panda, 1821 Grand Avenue, West Des Moines, IA 50265.

Individual/Family Recipient's Information

Recipient's Household Information

Additional Information

Referral's Information