Blue Santa

 

CHILDS NAME:______________________________________________________________________ AGE:____SEX:____

PARENTS NAME:___________________________________PARENTS PHONE:___________________________________

DELIVERY ADDRESS IF NEEDED:__________________________________________________________________________________________

DOES THE CHILD HAVE ANY SPECIAL NEEDS?:_____________________________________________________________

__________________________________________________________________________________________________

IF SO, PLEASE EXPLAIN:_______________________________________________________________________________

__________________________________________________________________________________________________

SOMETHING THE CHILD NEEDS:________________________________________________________________________

LIKES:_____________________________________________________________________________________

_____________________________________________________________________________

DISLIKES:______________________________________________________________________

READING/GRADE LEVEL:____________________ CLOTHING SIZE:________________________

Are there other children in the home?  Y     N     Were Forms Filled out   Y    N      How many?  _____

 

East Texas Press

PO Box 2594
Lindale, TX 75771
Office: (936) 254-5050
news@easttexaspress.com

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