WISH APPLICATION | cjklfm

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Christmas Wish Application

Child's First Name

Child's Last Name

Child's Age

Phone number

Email address

Child's Mother (first & last name REQUIRED)

Child's Father (first & last name REQUIRED)

Who does this child reside with?

Child's Home Address

What school does this child attend?

Grade

Gender

Child's pant size

Child's shirt size

Describe family situation

Submitted by/your name

Your phone number

Do you have full custody or shared custody of this child?

Your application has been submitted. Only successful applications

will be contacted.

Please do not contact CJKL FM regarding Christmas Wish applications

CJKL FM

P.O. Box 430

Kirkland Lake, Ontario

P2N 3J4

705.567.3366

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