Valentine's Card Club by Donation of 2024
Please complete and submit the form below if you would like AutismWish to send your child a special valentine's card this February! All information will be kept confidential and will not be shared with the public. This program is only open to U.S. residents, must have a U.S. address to apply. These cards require a $5.00 donation to be sent, your donation will cover the cost of envelopes, cards, postage, and envelope stuffers (e.g. stickers, etc.).

IMPORTANT: Deadline to submit is February 7th, 2024 by 11:59pm ET, but is subject to closing earlier if deemed necessary. Cards will be mailed after donation has been received. You will be contacted via the email you provide below to confirm your child's card so make sure to add info@autismwish.org to your contacts list and check your spam folders.
Sign in to Google to save your progress. Learn more
Email *
Donation Required To Receive Card

Please make your donation using CashApp, Venmo, or GiveSendGo and enter the contact information used to make the donation below so we can verify it. (e.g. if using CashApp, list your cashtag. If using Venmo, list your Venmo handle. If using GiveSendGo, enter the name/email used to make the donation). Once donation is verified, we will email your confirmation and send out the Valentine's Day Card. *
Did you make a $5 donation? *
Child's First Name *
Child's Gender *
Autism Symbol Selection
We support each individual's right to choose what symbol best represents them. Some stickers/tokens of appreciation may have the puzzle-piece symbol on them. Would you like us to exclude any puzzle piece symbols from your child's Valentine's Card? *
Mailing Address (U.S. residents only) 

Note: Please double check that your address is entered completely and accurately.  Inaccurate or missing addresses will not be considered.
 *
How did you hear about us? *
I understand that my information will be kept confidential and will only be used to send a Valentine's card to my child. I understand that I can ask AutismWish to delete this information from their system at any time by sending an email to info@autismwish.org. I understand submitting this form is not a guarantee my child will be selected to receive a valentine's card and that a complete and accurate mailing address is necessary as well as a $5.00 donation to qualify. I agree to have AutismWish send my child a Valentine's card to the address provided above. *
Required
Submit
Clear form
Never submit passwords through Google Forms.
This form was created inside of AutismWish. Report Abuse
Google Forms