Care Package Request - 12 and Under
* Required
Email address
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Your email
Your Name
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Your answer
Your relationship to the child
*
Your answer
Anonymous Gift
Yes
No
Other:
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City and State you live
*
Your answer
How you heard about us
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Your answer
Child's Name (First and Last)
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Your answer
Child's Age and Gender
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Your answer
Child's Mailing Address
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Your answer
If there are any other children living at this address who you want to send a care package to, please list name, age, and gender here.
Your answer
Who their lost loved one is:
*
Your answer
How they lost their loved one:
Your answer
By acknowledging this I am allowing Charlie’s Guys to send a gift to the child/ren referred and assuming responsibility for the gift once it has been delivered.
*
Yes
No
Are you interested in learning more about Charlie's Clubhouse - a way for bereaved kids to connect?
*
Yes
No
Are you interested in learning more about our grief therapy stipend program?
Yes
No
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