Shoes For Kids - Shoe Recipient Questionnaire (For Parent/Guardian)

Shoes For Kids - Shoe Recipient Questionnaire (For Parent/Guardian)

Purpose: To help us provide the best fit and service to children receiving shoes. **This form must be filled out and submitted within 24 hours.**

Contact Info
Parent/Guardian Name

Please include the best method of contact.
First NameLast Name
Parent/Guardian*

SingleMarriedDivorced
Phone Number*
Please enter a valid phone number.
Email*
example@example.com

Children(s) Information
1) Child's Full Name*

First NameLast Name
Child's Age*
Gender*

MaleFemale
Shoe Size*
Indicate shoe size
Favorite Color*
Indicate the child's favorite color.
2) Child's Full Name

First NameLast Name
Child's Age
Gender

MaleFemale
Shoe Size
Indicate shoe size
Favorite Color
Indicate the child's favorite color.
3) Child's Full Name

First NameLast Name
Child's Age
Gender

MaleFemale
Shoe Size
Indicate shoe size
Favorite Color
Indicate the child's favorite color.
4) Child's Full Name

First NameLast Name
Child's Age
Gender

MaleFemale
Shoe Size
Indicate shoe size
Favorite Color
Indicate the child's favorite color.
5) Child's Full Name

First NameLast Name
Child's Age
Gender

MaleFemale
Shoe Size
Indicate shoe size
Favorite Color
Indicate the child's favorite color.
School Name (If applicable)
PHOTO RELEASE WAIVER

I, the undersigned, hereby grant permission to Northco Development, Inc. and its representatives to take photographs and/or video of me and/or my child(ren) during this shoe distribution event.

I authorize Northco Development, Inc. to use these images and/or videos in printed or digital media, including but not limited to websites, social media, flyers, or reports, for the purpose of sharing the organization’s work with the public and supporters.

I understand that:
- No compensation will be provided for the use of these images.
- Images may be used without names.
- I can revoke this consent at any time in writing, but it will not affect any images already used.
Parent/Guardian Name

First NameLast Name
Signature*

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Shoes For Kids - Shoe Recipient Questionnaire (For Parent/Guardian)

Parent/Guardian Name