Customer Details:
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PARENTS MUST ATTEND EVENT WITH CHILD(REN)
No exceptions. Children without adults will be asked to call their parents and request to be picked up immediately.
Parent's Full Name
*
First Name
Last Name
Phone Number
*
Format: (000) 000-0000.
E-mail
*
example@example.com
Do you live in the Child's Park Neighborhood?
*
Yes
No
How many school age children do you need supplies for? (School age is 5-17 yrs old)
*
1
2
3
4
5
6
Are you concerned about the violence in the community?
*
Yes
No
Name(s) of children coming to the event?
*
What are you looking to get out of this event?
*
Mental Health Awareness
School Supplies
Parent Support
Outside Activities
Entertainment
Outreach Services
Nutritional Education
Do you or your children need help with conflict resolution? (Conflict resolution means the process that two or more parties use to find a cordial solution to a problem.)
*
Yes
No
Not sure what that is
Would you be willing to volunteer at upcoming community events?
*
Yes
No
Submit
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