Care Package Request - 12 and Under
Email address *
Your Name *
Your relationship to the child *
Anonymous Gift
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City and State you live *
How you heard about us *
Child's Name (First and Last) *
Child's Age and Gender *
Child's Mailing Address *
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.
Who their lost loved one is: *
How they lost their loved one:
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. *
Are you interested in learning more about Charlie's Clubhouse - a way for bereaved kids to connect? *
Are you interested in learning more about our grief therapy stipend program?
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