For The Child » Circle of Friends Registration Donation

Let’s Rock for Kids

900+ VULNERABLE CHILDREN COME THROUGH OUR DOORS EVERY YEAR.

Please join us at our 1950’s themed breakfast, bring a friend, and help give healing and joy to child victims of abuse, neglect and violence.

THANK YOU FOR BEING A FRIEND!

Your Information
Name:*
First Last
Address:*
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Email:*
Phone:*
Invited By:
Your Registration/Donation
I would like to be contacted with information to become a:
- Gold Prevention Partner $2,500
- Silver Prevention Partner $1,500
- Table Captain $1,000
I would like to:*
- I would like to attend.
- I cannot attend but would like to make a donation.
- I am interested in information before registering or making a donation.
I would like seats for me and my friends:
Please enter how many seats are needed.
I would like to simply donate:*