Foster Care Program Event Registration
Event Timing: 8:45am-3:45pm, 4 days: July 14, 15, 21, 22, 2018
Event Location: 3003 Scott Blvd. Santa Clara, CA 95054 -- MCA, Maryam Banquet Hall
For Questions/Concerns, Contact Br. Khaled Hamade at 1(408)472-7888 or
Email address *
Applicant's Name (First, Last) *
Your answer
Co-Applicant's (i.e. spouse) Name (First, Last) *
Your answer
Applicant's Cell-Phone [ 1(***)***-**** ] *
Your answer
Co-Applicant's Cell-Phone [ 1(***)***-**** ] *
Your answer
Co-Applicant's Email *
Your answer
Co/Applicant's Address [ 1234 Street Name (apt/suite/unit if applicable), City Name, ST 56789-0123 ] *
Your answer
Do you need baby sitting for your child(ren)? *
If YES, how many kids and what age(s)?
1st Child
2nd Child (if applicable)
3rd Child (if applicable)
4th Child (if applicable)
1 yr
2 yrs
3 yrs
4 yrs
5 yrs
6 yrs
If YES, what day(s)?
Do you have any final comments, questions, or concerns?
Your answer
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