Memories Birthday Questionnaire
Woohoo! Memories Foundation is excited to celebrate the birthdays of youth in foster care! Please complete all of the information below to help us create a special birthday experience for the youth. Once your submission is received, you will receive a confirmation email. An additional email will be sent to coordinate the best date and time to deliver the birthday package.We look forward to celebrating with you soon!
Foster Youths Name(1-21)
First Name
Middle Name
Last Name
Birth Date
Please select a month
January
February
March
April
May
June
July
August
September
October
November
December
Month
Please select a day
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
Day
Please select a year
2026
2025
2024
2023
2022
2021
2020
2019
2018
2017
2016
2015
2014
2013
2012
2011
2010
2009
2008
2007
2006
2005
2004
2003
2002
2001
2000
1999
1998
1997
1996
1995
1994
1993
1992
1991
1990
1989
1988
1987
1986
1985
1984
1983
1982
1981
1980
1979
1978
1977
1976
1975
1974
1973
1972
1971
1970
1969
1968
1967
1966
1965
1964
1963
1962
1961
1960
1959
1958
1957
1956
1955
1954
1953
1952
1951
1950
1949
1948
1947
1946
1945
1944
1943
1942
1941
1940
1939
1938
1937
1936
1935
1934
1933
1932
1931
1930
1929
1928
1927
1926
1925
1924
1923
1922
1921
1920
Year
Gender
Please Select
Male
Female
Non-Binary
Other
Do Not Wish To Answer
What's the Best Day & Times to Deliver the Birthday Package?
Birthday Delivery Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Mobile Number(For Delivery Coordination)
Format: (000) 000-0000.
E-mail Address (For Delivery Coordination)
example@example.com
How Old Will This Youth In Care Be Turning?
Foster Family's Phone Number
Please enter a valid phone number.
Format: (000) 000-0000.
How Did You Learn About Memories Foundation?
Please provide the name of your foster care agency
Is this youth uncomfortable around loud sounds or noises?
Please Select
Yes
No
Name & Email Address of Person Submitting The Form(If you are not the main point of contact)
What Type Of Birthday Treat Do You Prefer?
Please Select
Cake
Cupcakes(Dozen)
Snickerdoodle Cookies (Dozen)
Chocolate Cookie Cake
No desserts please
How many people should the birthday treat serve?
Birthday Treat Color Option- What Color Scheme Would You Like?(Does not include cookies)
Please Select
Pink
Blue
Yellow
Purple
Orange
Green
Red
Pick A Treat Flavor
Please Select
Vanilla
Chocolate
Allergy Restrictions(Please put N/A if there are none)
List 5 Gifts From Foster Youths Wish List (Maximum $75 worth of value)
Birthday Card Type
Please Select
Birthday Card written from Memories Foundation only
Birthday Card with your name included
What Name/Names Would You Like The Birthday Card To Be From?
First Name
Last Name
Please Provide What You Would Like Written in The Card?
Please add any emails that you would like to be included in the birthday delivery coordination. Please be sure to add social worker's information
Submit Application
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