2018 Deserving Children's Shopping Tour Chaperone Form (La Porte Tour)
Please fill out the information below for you and your partner. The shopping tour will take place on Tuesday, December 4th! If you have any questions please email Kim and Kristian at (lpjayceesdcst@gmail.com).
Email address *
In order to provide a safe experience for all children on the tour we may conduct a background check on you. If you are willing to allow a background check to be done, please check yes. Please note that checking no will mean that we will not assign you any children to take. Thank you in advance. *
Required
Last Name *
Your answer
Middle Name *
Your answer
First Name *
Your answer
Home Address *
Your answer
City *
Your answer
State *
Your answer
Zip Code *
Your answer
Phone Number *
Your answer
Birthday *
MM
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DD
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YYYY
The number of children we are willing to take is *
Personal Reference *
Your answer
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