Project Wee Care Submission – Form Test - Millard Business Community Foundation

Family Information

Parent/Guardian Name(Required)

First Last

Parent/Guardian Address(Required)

Street Address Address Line 2 City State ZIP Code

Email(Required)

Phone

How would you like to be contacted?(Required)

Do you need transportation to and from the "North Pole" on December 9?(Required)

Yes

Ethnicity Requested (please select one)(Required)

Who nominated you for Project Wee Care?(Required)

How many people in your household?(Required)

Please enter a number greater than or equal to 2.

How many children do you have from infant to high school senior that match your school registration? (up to 6)(Required)

Please enter a number from 1 to 6.

When you go out for a fun family outing, where do you go and/or what do you do (specific restaurants, activities, outings)?

When you have an adult night out, where do you go and/or what do you do (specific restaurants, activities, outings)?

If you have a family pet, tell us what kind of pet and a little information about your pet.

Child 1

Name(Required)

First Last

Age as of December 9(Required)

Does this child need diapers?(Required)

Yes

What is the anticipated size of diapers for this child as of December 9?

School Attending(Required)

Current Grade:(Required)

Gender(Required)

What needs does this child have?(Required)

Examples: clothing, coats, boots, athletic apparel

Please provide sizes(Required)

Please provide favorite colors(Required)

What fun gifts would this child enjoy?(Required)

What interests, hobbies and activities does this child enjoy?(Required)

Child 2

Name(Required)

First Last

Age as of December 9(Required)

Does this child need diapers?(Required)

Yes

What is the anticipated size of diapers for this child as of December 9?

School Attending(Required)

Current Grade:(Required)

Gender(Required)

What needs does this child have?(Required)

Examples: clothing, coats, boots, athletic apparel

Please provide sizes(Required)

Please provide favorite colors(Required)

What fun gifts would this child enjoy?(Required)

What interests, hobbies and activities does this child enjoy?(Required)

Child 3

Name(Required)

First Last

Age as of December 9(Required)

Does this child need diapers?(Required)

Yes

What is the anticipated size of diapers for this child as of December 9?

School Attending(Required)

Current Grade:(Required)

Gender(Required)

What needs does this child have?(Required)

Examples: clothing, coats, boots, athletic apparel

Please provide sizes(Required)

Please provide favorite colors(Required)

What fun gifts would this child enjoy?(Required)

What interests, hobbies and activities does this child enjoy?(Required)

Child 4

Name(Required)

First Last

Age as of December 9(Required)

Does this child need diapers?(Required)

Yes

What is the anticipated size of diapers for this child as of December 9?

School Attending(Required)

Current Grade:(Required)

Gender(Required)

What needs does this child have?(Required)

Examples: clothing, coats, boots, athletic apparel

Please provide sizes(Required)

Please provide favorite colors(Required)

What fun gifts would this child enjoy?(Required)

What interests, hobbies and activities does this child enjoy?(Required)

Child 5

Name(Required)

First Last

Age as of December 9(Required)

Does this child need diapers?(Required)

Yes

What is the anticipated size of diapers for this child as of December 9?

School Attending(Required)

Current Grade:(Required)

Gender(Required)

What needs does this child have?(Required)

Examples: clothing, coats, boots, athletic apparel

Please provide sizes(Required)

Please provide favorite colors(Required)

What fun gifts would this child enjoy?(Required)

What interests, hobbies and activities does this child enjoy?(Required)

Child 6

Name(Required)

First Last

Age as of December 9(Required)

Does this child need diapers?(Required)

Yes

What is the anticipated size of diapers for this child as of December 9?

School Attending(Required)

Current Grade:(Required)

Gender(Required)

What needs does this child have?(Required)

Examples: clothing, coats, boots, athletic apparel

Please provide sizes(Required)

Please provide favorite colors(Required)

What fun gifts would this child enjoy?(Required)

What interests, hobbies and activities does this child enjoy?(Required)

Project Wee Care Submission – Form Test

Project Wee Care Registration

Family Information

Child 1

Child 2

Child 3

Child 4

Child 5

Child 6

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Millard Business Community Foundation