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*Corporate / Group Name

*Type of Group

*How many are in your group?

Contact Information

*First Name

*Last Name

*Address

*City

*State

*Zip

*Primary Phone

*Cell Phone

*Email

Availability & Preferences

*Our volunteer date/time is flexible

Yes

No

We have a preferred volunteer date

*Preferred volunteer time

Morning (9 am - Noon)

Afternoon (Noon - 5 pm)

Full day (9 am - 5 pm)

*Volunteer activity preference

Wall of Windows - $1,000

Let's Party - $1,500

Super Stuffer (Welcome, Snack Pack, or Activity Bags) - Bags and contents to be provided by volunteers as an in-kind donation

Undecided at this time

Does your employer promote volunteer activities?

Yes

No

Not sure

If yes, please explain how they promote activities

Is this part of a larger service day program?

Yes

No

Donation Processing

To process your donation please make your check payble to Children's Specialized Hospital Foundation and mail to the following address:

Children's Specialized Hospital Foundation
150 New Providence Road
Mountainside, NJ 07092

Please confirm security question above

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