Donor Information

The Sandbox Logo

CARRE Family Application

Please complete the information below. Completing this information as accurate as possible will help us provide you the best support possible. Thank you!

One form per Honoree please.

Honoree's are the children we serve.

* Required Fields

Honoree Information (Use Guardian/Parent email and phone)

First Name

Last Name

Address

Address 2

City

State/Province

Zip/Postal Code

Home Phone

Parent First Name

Parent Email

Parent Cell Phone

Check here if parent listed lives in the same household as Honoree

Please provide secondary parent contact information where applicable:

Parent First name

Parent Email

Parent Cell Phone

Check here if parent listed lives in the same household as Honoree

Honoree/Medical Information

Nickname (Honoree)

Birthdate

Gender

Primary Diagnosis

Secondary Diagnosis

Limitations

Concerns

Primary Facility for Care/ Treatment

Social Worker(s) and their Contact Info

Permission to Contact Social Worker

Top 3 Concerns outside of the health of your child and financial needs

Honorees Interest & Hobbies

Additional Information about Honoree and Family

Parent/ Guardian First and Last Name

Your Name & Relationship to Honoree if not a parent or guardian

Your Phone Number if not a parent or guardian

Marital Status

Spouse

Custody Agreement

Preferred Method of Communication of family

Members of Household & their relationship to Honoree, ages if children

Language Spoken in Home

What other organizations that offer assistance are you currently working with?

What organizations have you worked with in the past?

Recently, have you been in jeopardy of losing house, car or utility bills being turned off?

Photo Release Authorization

I grant to The Sandbox, its representatives, and employees the right to take photographs of me and my property (related or connected individuals) in connection with the Sandbox Organization. I agree that The Sandbox may use such photographs for any lawful purpose, including for example such purposes as publicity, illustration, advertising, and Web content. By entering your first, middle, and last name in the box below, you are agreeing to the above statement.

The Sandbox l 9935 D Rea Road #107 l Charlotte l North Carolina l 28277

[email protected] l 980.224.0231