Warm the Children Program 2022
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Parent/Guardian *
Parent/Guardian Phone *
Parent/Guardian Email Address *
Alternate Contact Name
Alternate Contact Phone
Alternate Contact Phone
CHILD #1 Name
CHILD #1 Date of Birth AND Age
Child #1 Gender
Clear selection
CHILD #2 Name
CHILD #2 Date of Birth AND Age
Child #2 Gender
Clear selection
Child #3 Name
Child #3 Date of Birth AND Age
Child #3 Gender
Clear selection
I understand Warm the Children is a program that buys new winter clothing for children from families in need.  Children served are ages up to 18.  The Family must provide its own transportation to Walmart in Old Saybrook where shopping takes place.  A volunteer shopper is assigned to facilitate shopping and handle paperwork *
I understand that if I do not meet the shopper as agreed, I will be dropped from the program and must reapply. *
I understand that if the shopper is unable to contact me,  I will be dropped from the program and must reapply. *
I will not hold Warm The Children, LYSB, or the Community Foundation of Middlesex County Inc, the Shopper, and/or Wal-Mart liable in any way in the event of an adverse result from the shopping trip. *
I understand that I am responsible for my own transportation to Wal-Mart, and that under no circumstances will my Warm the Children Shopper provide transportation. *
My agreement below 1) is a request for my children to participate in this program; 2) represents my permission for them to do so, and 3) allows the use of their names and my name and telephone number by the local Warm The Children Coordinator and Shoppers.  The amount allowed is based on $40 per child less than 4 years old, and $80 per child up to age 18, or still in high school. *
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