Our College Ministry usually sends out two "care packages" each year and may send out other mailings such as birthday cards, etc.

Personal and Contact Information of the Participant

Name of Participant *

Birthday (month/day) *

Gender

Male

Female

Name of School *

School Street Address 1 *

School Street Address 2

School City *

School State

School Zip *

Or type in state, if not listed in other box.

Year in School 2013-2014 *

Email Address Student

Cell Phone of Student

1. Does this child have Food allergies or restrictions? *

Yes

Please Specify

Home Address
*

City *

State

Or type in state, if not listed in other box.

Zip *

Parent's/Guardian's Name *

Cell Phone (Include Area Code) *

Home Phone (Include Area Code)

Please type what you see below. *
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