Jackson Township Professional Firefighters IAFF Local 2672
 

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Firefighters for Kids Sign-up Form
  To register your child for help with this year's Christmas gifts, please provide the following information:
    Parent's Info:  
  * First Name:

  * Last Name:

  * eMail:

  * Street 1:

    Street 2 / Appt No:

  * City:

  * State:

  * Zip/Postal Code:

  * Phone No:

       
    Children Names, Ages and Genders:
    First Name Age

Gender

Special Needs:
  1

Female Male

Autism

CP

MRDD

 

  2

Female Male

Autism CP MRDD
  3

Female Male

Autism CP MRDD
  4

Female Male

Autism CP MRDD
  5

Female Male

Autism CP MRDD
  6

Female Male

Autism CP MRDD
  7

Female

Male

Autism CP MRDD
  8

Female

Male

Autism CP MRDD
  9

Female

Male

Autism CP MRDD
  10

Female

Male

Autism CP MRDD
   

         

Restrictions: 1This program is only applicable to children 12 years old or younger.

                     2Eligible children must reside in Jackson Township, Grove City or Urban Crest.


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Copyright 2009 Jackson Township Professional Firefighters Local 2672
Last modified: 11/02/09