2022 Graduation Cake Request Form

Foster Children's High School/College Graduation and GED Completion Cake Request Form

*We ask that caregivers provide us with a minimum notice of 10 days to order custom cakes. You must hit SUBMIT Button for your registration to go through*
This opportunity to receive a custom graduation cake is available to teens who are in foster care, DCS kinship, tribal foster care, DCS guardianship, or aged out youth graduating from high school or college, or completing a GED in 2022. At this time we are only providing cakes for high school or college graduations and GED completion, not preschool, elementary, or middle school.

Our Mesa location is 7830 E. University Dr, Mesa 85207, just east of Sossaman on University. Please Note, you must call 623-428-1592 to confirm that your submission has been received.

Cake requests MUST be received 10 days prior to the desired pickup date. We will order your cake to be delivered between 9 am and noon on the date you choose. Once the cake arrives at Jacob's Mission Community Center, we will notify you that it's ready to pick up.
Are you an (check all that apply) *

Unlicensed Kinship Licensed Kinship Licensed Foster Family Tribal Foster Family Guardianship Family Youth from Foster Care Licensed Group Home
What events are you interested in learning more about? (check all that apply) *

Jacob's Mission Community Center (after school tutoring, art, dance, piano, guitar, karate, life skills, sports) Foster Hope New Placement Bags filled with essentials Foster Hope Food Box for Families in Need Foster Hope School Backpacks Foster Children's Birthday Party Life Skills Workshops (age 12 and over) such as cooking, framing, electrical, drywall, coding, gardening Jacob's Law Presentation (behavioral health timelines) Clothing from our 24/7 Giving Closet Parent's Night Out for Foster, Kinship & Adoptive Families Family Socials (get to know other families) for Foster, Kinship & Adoptive Families Christmas Event for Foster, Kinship & Adoptive Families Christmas Gifts for Kinship & Foster Families in Need Yearly Couples Retreat Yearly Trauma Mama Retreat Monthly Support Group Volunteering Opportunities Resources and Trainings for Caregivers (Trauma Training, in-the-moment skills, IEP, etc)
Caregiver or Parent's Name # 1 *

Last Name First Name
Caregiver or Parent's Name # 2 (type N/A if not a 2 parent home) *

Last Name First Name
Current Address *

Street Address

City Postal/Zip Code

COUNTY you reside in
Cell Phone Number *

Area Code Phone Number
E-mail *
Total Number of People Currently Living in the Home? *
Includes all Adults and Children
Total Number of Adults Living in the Home (including children over 18 who are no longer in high school) *
Total Number of Children Living in the Home (including children over 18 who are still in high school) *
Number of Children in Foster Care, Tribal Foster Care, or DCS Guardianship Living in the Home (including those 18 and over who are still in high school) *
Kinship is included in this number since they are in the custody of DCS
Number of Adopted Children Living in the Home (including children 18 and over who are still in high school) *
Number of Biological Children Living in the Home (including children 18 and over who are still in high school) *
Number of NON-DCS Kinship or NON-DCS Guardianship Children Living in the Home (including children 18 and over who are still in high school) *
If you have a FOSTER CHILD graduating from HIGH SCHOOL to register click YES and enter their information from youngest to oldest.

Yes I have a foster child to register

Click Here to Consent
By submitting this request and/or attending this event, you consent to interview(s), photography, audio recording, video recording and its/their release, publication, exhibition, or reproduction to be used for news, web casts, promotional purposes, telecasts, advertising, inclusion on websites, social media, or any other purpose by ASA Now. Images, photos, and/or videos may be used to promote similar ASA Now events in the future, highlight the event and exhibit the capabilities of ASA Now. You release ASA Now, its officers and employees , and all persons involved from any liability connected with the taking, recording, digitalizing, or publication and use of interviews, photographs, computer images, video and/or sound recordings. By entering the event premises, you waive all rights you may have to any claims for payment or royalties in connection with any use, exhibition, streaming, web casting, televising, or other publication of these materials, regardless of the purpose or sponsoring of such use, exhibiting, broadcasting, web casting, or other publication irrespective of whether a fee for admission or sponsorship is charged. You also waive any right to inspect or approve any photo, video, or audio recording taken by ASA Now or the person or entity designated to do so by ASA Now. You have been fully informed of your consent, waiver of liability, and release before entering the event.
I have reviewed, understand, and agree to comply with the above terms *

Agree
Liability Release - I do hereby release ASA Now, Jacobs Mission Community Center, their agents, employees, personal representatives, affiliates, and any and all persons, firms or corporations liable or who might be claimed to be liable, whether or not herein named, from any and all claims, demands, damages, actions, causes of action or suits of any kind or nature whatsoever, arising out of or in any way relating to injuries and damages, as a result of being present on Jacobs Mission Community Center property. I recognize that there may be inherent risks associated with attending this event. You have been fully informed of your consent, waiver of liability, and release before entering the event.
I have reviewed, understand, and agree to comply with the above terms *

Agree
Signature *

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Foster Children's High School/College Graduation and GED Completion Cake Request Form