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Brick Church Mouse Questionnaire
For members of Brick Church whose children are in college or at boarding school. Sign up if you would like your child to receive care packages from a "church mouse".
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* Indicates required question
Your name
*
Your answer
Your Email Address
*
Your answer
Child's Name (Please fill out separate forms for each child)
*
Your answer
School Mailing Address
*
Your answer
Which grade is your child currently in?
Your answer
Child's Birthday
*
MM
/
DD
/
YYYY
School exam period or any other stressful time during the year when they might need a pick me up :)
*
Your answer
Spring break dates and any other time when they will be away from campus
*
Your answer
Favorite Treats
Your answer
Interests and hobbies?
Your answer
Any food dislikes or allergies?
Your answer
Anything else you would like your child's Church Mouse to know?
Your answer
Would you be interested in being a Church Mouse for another student?
Yes
No
Maybe
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