Request A Packing Date

Contact Information

Fields marked with a star () are required and must be completed in order to submit the form.

Name

Email

Primary Phone

Alternate Phone

Have you packaged with us before? Yes No

Group Information

Organization | Group Name

Street Address

City

State

Zipcode

My group can raise

Group Composition

Estimate the number of adults, youth & children who may be participating.
Keep in mind that 2 adults are required for every 10 youth (under 18 years old).

Adults (ages 18+)

Youth (ages 13-17)

Children (ages 5-12)

Total Group Size

Preferred Date & Time

Please choose your preferred date as well as an alternate date in case the first is unavailable.
Please choose the period of the day which would best suit your group.
For other concerns you may have, please note the details of your request in the comment section below and we will do our best.

Preferred Date (mm/dd/yyyy)

Alternate Date (mm/dd/yyyy)

Best Time of Day

Questions or Comments

Security

Please enter the following word in the space provided. If you're unable to read the letters, use the REFRESH icon to generate a new word.

A Heart Like His Foundation, Inc.	A Heart Like His Foundation, Inc. is a 501(c)(3) tax-exempt charity.
P.O. Box 453368
Fort Lauderdale, FL 33345
954.793.2487
Nmay@aheartlikehisfoundation.org

A HEART LIKE HIS FOUNDATION