This form sends an e-mail to Angel Helpers Staff.

If you experience any problems using this form please, copy and paste the entire form into the body of an e-mail and mail it to countryangelmomdawn@yahoo.com

IMPORTANT: Complete this form entirely, carefully and honestly, please!

Child's First Name:
Child's Last Name:
Child's House Number (please still fill in if you have a PO Box, this is for our records only):
Child's Street Name (please still fill in if you have a PO Box, this is for our records only):
Child's Complete Mailing Address (this is if mailing address is different from above and is also for PO Boxes):
Child's City:
Child's State:
Child's Zip Code:
Child's Email Address (if he/she has one of their own and you have internet access):
Child's Phone Number, Including Area Code (where they can be reached, for our records only, we will only call if we can not get in touch with them by e-mail or snail-mail):
Child's Birthday (month, day and year):
Child's Homepage (if they have one):
Child's Current Age:
Child's Gender (boy or girl):
Does the child have internet access (please state yes or no):
Does the child like to be called by a nickname (please state yes or no, if yes, please state nickname):
Parent/Legal Guardian's First Name:
Parent/Legal Guardian's Last Name:
Parent/Legal Guardian's Complete Mailing Address (please include street address and if you use a PO Box include it as well):
Parent/Legal Guardian's Email Address (if have you have internet access):
Parent/Legal Guardian's Phone Number, Including Are Code (where they can be reached, for our records only, we will only call if we can not get in touch with you by e-mail or snail-mail):
Do you as the parent/legal guardian have internet access (please state yes or no):
How did you hear about Angel Helpers (this is just so we can see where most of our advertising is from):
Please tell us why you think the child needs Angel Helpers:
Please tell us what you expect your child to get out of Angel Helpers:

IMPORTANT: The following Questions for Parents/Legal Guardians are Optional and in no way will effect your child from being in Angel Helpers:

Parent/Legal Guardian's Birthday (month and day)(this is so we can send a birthday card from the Angel Helpers Staff, this is not essential for your child to be in Angel Helpers):
Parent/Legal Guardian's Homepage (if you have one and would like to share it):
Parent/Legal Guardian's Are You A Teen Mom or Dad (this is optional) please state yes or no:
Parent/Legal Guardian's Gender (yes, even if you are a single father we still accept child in our program, we just like to know since so many guy names can be girls names as well, this is optional but helpful):
Do you as the parent/legal guardian have internet access (please state yes or no):
Additional Comments: This is where you can tell us what sizes your child wears, the needs of the child, the likes/dislikes the child may have or anything else about the child you want us to know; (also feel free to tell us anything you want, just don't use nasty language):

Please only submit this form once!

Thanks,
Angel Helpers Staff

Please know we do not keep your information stored on an online data base or computer, everything is kept off line on a diskette for our records only, this is so that no one at any given time can just access your information for any reason what-so-ever, it is for Angel Helpers Staff only! This is also for your protection and privacy, since we live in a world that has so much danger, we must take every precaution to provide safety for our kids here at Angel Helpers.

The Angel Helpers Staff, respects your right to privacy and will not in any way what-so-ever, at any time, give out, share or sell your information to any third parties for any reason, not even with prior written permission from you. We believe if you want to give it out to anybody but us here at Angel Helpers you should do that. Also we believe that it is not our responsibility to do so for any given reason at all. So your privacy is protected with us here at Angel Helpers.

All content, backgrounds and images are © by Angel Helpers
Angel Helpers © 2003
All Rights Reserved by Angel Helpers
Page Last Updated: August 27, 2003