Wordy press form 2

Child Information
Child's first Name*
Child's last Name*
Gender
- Male
- Female
Age
Date of Birth
Month
Day
Year
School
Grade
Parent Information
Parent/Guardian
Email Address*
Contact Information
Mailing Address
City State ZIP Code
Phone Number*
Comments/ Concerns/ Areas of interest/ Other important information:
Comments/ Concerns/ Areas of interest/ Other important information:
Friends @ Home
When would you like the volunteers to come and visit your home?
Make first choice
Make second choice
Make second choice
Do you prefer having:
- The same volunteers as last year, if available
- New volunteers
It is our pleasure to provide you with our Friends at Home service. However it is necessary for parent/guardian to assume responsibility to oversee activities shared together.
- I/We agree that a parent or legal guardian will be home at all times while volunteers are interacting with my/our child.
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Email
This field is for validation purposes and should be left unchanged.

Child Information