Cost
Qty.
Total
Smooth Moves Luggage Campaign:
 
• Piece of new luggage
$15.00
Secret Santa Bicycle Campaign:
 
• Large bicycle for older children
$45.00
• Small bicycle for younger children
$35.00
Send-a-Bear to Foster Care Campaign:
 
• Teddy bear
$ 5.00
Other Amount Donated:    
TOTAL  

Method of Payment: Mastercard  Visa   American Express    
Credit Card Number:
Expiration Date:  Month: Year:
Name on Card:
Please Dedicate this Gift To:
Will your employer match your gift to Communities for Children? yes  no    
(If yes, please ask your Human Resource Manager to sumbit a matching gift form)
Your name:
Company (if applicable):
Address:
City:   
State:      Zip Code:
Telephone:
Email Address:

Please fill out form, print and fax to Communities for Children at 770-640-6073.
   
Funded in part by Georgia Department of Human Resources, Division of Family and Children Services, Foster Care Unit