Print out
this form and return or fax forms to:
2124 WEST MUHAMMAD ALI BLVD * LOUISVILLE, KY 40212 * P.O. BOX
11366 (40251-0366) * 502-772-1225 * FAX 502-775-6966
Return to Clothe-A-Child by Monday, November 1, 2004
Dear
Volunteer:
Thank
you for volunteering your time to participate in the Christmas School Clothing Program
on Sunday, December 12, 2004, 6:00 a.m. – 11:00 a.m., at Sears in Oxmoor Mall
(St. Matthews). Prior to making a
commitment, we encourage you to check your calendar to be certain that you can
pick up children on the day of the event.
NOTE: Background Checks will be conducted on all
Volunteers.
…………………………………………………………………………………………………………………………………
Last
Name________________________________First
Name_____________________________Middle Inital_________
Social
Security _____________________________
Date of Birth _______________
(necessary to process form)
Employed
by:______________________________________________________________________________________
Work
Address______________________________________________ Work Phone
Number______________________
City_______________________________________
State____________________ Zip Code_______________________
Home
Address_______________________________________________________________________
Apt.#__________
City_______________________________________
State____________________ Zip Code_______________________
Home
Phone Number______________________________ Cell
Phone________________________________________
Clothe-A-Child needs your
home number in case of an emergency.
Email
Address____________________________________ Pager
Number______________________________________
|
DO NOT WRITE IN THIS AREA Child/Children: 1.______________________________________________
2._____________________________________________ 3.______________________________________________4.________________________________________________ Parent Name:________________________________________________ Parent SS#____________________________ |
Please indicate your choice below with a check mark
in all applicable box(s)
( )
Yes, I wish to pick-up a child/children at his/her home and clothe him/her in
the store.
If yes, how many children can you transport? ___
( ) Yes, I will sponsor a child/children. Enclosed is my check for $____________