ASA Now Birthday Request Form

🌟 BIRTHDAY PARTY FOR CHILDREN IN FOSTER CARE 🌟

At ASA Now, we believe that every child deserves to feel special on their birthday. For many children and youth in foster care, their birthdays can sometimes be overlooked. That's where Jacob's Birthday Wishes steps in to ensure every child gets to celebrate their special day with a big birthday celebration surrounded by foster/adoptive families who care.

THIS REGISTRATION CONFIRMS YOUR CHILD WILL RECEVE A CAKE AND GIFTS TO ENJOY BIRTHDAY CELEBRATION.

Please Note: Request must be made at least 12 days in advance and pick up days are Tuesday through Friday

Here's what we offer:

🍰 Custom Cake

🎁 Gifts

📚 Book

🧸 Stuffed Animal

🧣 Blanket

📍 Location: ASA Now - Jacob's Mission Community Center

🏠 Address: 7830 E. University Dr. Mesa, AZ 85207

Please take a few moments to fill out this form for your foster child with a birthday within the next 45 days.

Please select the date from below that you would like to pick up all items from our office at University and Sossoman in Mesa. Request can be made between 12 days to 45 days in advance.

IF YOU HAVE A NEW PLACEMENT WITH A BIRHTDAY WITHIN THE NEXT 12 DAYS PLEASE CALL THE CENTER

City

Caregiver First and Last Name

Cell Phone Number (for text message reminders)

Format: (000) 000-0000.

Name of Group Home (type N/A if child is not in a group home)

Are you an (check all that apply)

Birthday Child's Legal First and Last Name

Birthdate (ex: 10232018)

(please enter the date with no dashes between month, day and year)

Age child is turning

Please upload this child's Notice to Provider

What licensing agency are you with? (unlicensed kinship should also have a licensing agency)

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)

Ethnicity of Child:

Please complete the information below for us to complete the custom cake request for the child.

Cake Flavor. Please select ONE flavor

Frosting Type. Please select ONE

Frosting Flavor. Please select ONE flavor

Preferred Name For Cake if different from Legal name

Gender of Child:

Favorite Character or Interest for Cake Theme

Please share any additional information about this child that will help us choose gifts they will enjoy.

Please enter E-mail for confirmation

example@example.com

I have reviewed, understand, and agree to comply with the above terms and understand the request must be made 12 days in advance and child has to currently be in foster care

I understand I must pick up items to be eligible for future request

If you have another birthday request please cpmplete the form again

Signature