2019 Deserving Children's Shopping Tour
Please fill out the form below if you wish to be a chaperone for the 2019 shopping tour. Please fill out your partner's information as well. Only one form needed per pair of chaperones. All information must be filled in.Thank you. For any questions please email lpjayceesdcst@gmail.com.
Email address *
Phone Number *
Your answer
First Name *
Your answer
Middle Name *
Your answer
Last Name *
Your answer
Date of Birth *
MM
/
DD
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YYYY
Home Address *
Your answer
I wish to participate in the following tour-Michigan City will take place on 12/11/19. LaPorte is currently full. *
I want to take the following number of children shopping (which means you have room for them in one vehicle with your partner). *
I give permission for a background check to be done. Without checking yes I know that I cannot take children shopping. *
Please list one personal reference with phone number that we can call before allowing you to be a chaperone. *
Your answer
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