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Maya's Love Care Package Request
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* Indicates required question
Email
*
Your email
Child First and Last Name
*
Your answer
Allergies
*
Yes
No
Other:
If you answered yes, what are you allergic to?
Your answer
Age
*
Your answer
School Grade
*
Your answer
Favorite characters
*
Your answer
Child favorite things
*
Your answer
Tell us a little about why you are requesting a care package.
*
Your answer
Parent Name and Last Name
*
Your answer
Mailing Address
*
Your answer
City, State
*
Your answer
Anything else you would like to share...
*
Your answer
Send me a copy of my responses.
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