Download pdf - sk8shoes4kids.org referral form

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Page 1: sk8shoes4kids.org referral form

Approved Date:

Name: Age:

Contact #: Shoe Size:

Explanation of how you/individual qualifies for shoes:

All information is confidential, unless you/individual signs a release of information form.All applications can be dropped off at Freedom Quest 349 Columbia Ave., Castlegar

Phone 250-304-2676 for more info.

Self Referral Professional Referral

Regional Youth Services

FREEDOMQUEST

CRITERIA: This program is designed for children and youth 18 yrs. & underwho cannot otherwise afford shoes due to financialmeans.Those that apply will not have a choice of shoe but willbe given new name brand skate shoes.

Street Dreamz Boardshop Inc. 7923 120th Street, Delta B.C. CANADA

Phone: 604 - 590 - 4553 Email:[email protected]

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