Blue Santa Sign Up Form

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Child's Full Name(*)

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Child's Age(*)

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Parent/Guardian’s Full Name(*)

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Parent/Guardian’s Address(*)

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City(*)

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State(*)

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Zip Code(*)

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Parent/Guardian’s Email(*)

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Parent/Guardian’s Cell Phone(*)

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Parent/Guardian’s Home Phone(*)

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Has this child participated in the event before?(*)

YesNo

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If yes, what year?

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How did you find out about Blue Santa?(*)

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Please understand that we cannot select all children nominated for this event. Any additional information you can provide may help us with the selection process.

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