Sponsor a Child Form

Please provide us with the following contact information.

Name:

Group/Business:

Address:

City:

State/Province:

Zip/Postal Code:

Country:

Home Phone:

Work Phone:

eMail Address:

How would you like to choose a child to sponsor?

Please select a child for me from the waiting list.

I prefer to specify the gender of the child I want to sponsor.

Boy

Girl

Either

Sponsorship Payment

Child sponsorship is $30 US a month. You may give monthly, quarterly or yearly. Payment can be made by check or money order to Mission To Haiti when you receive information by mail. You may also charge your offering on-line upon completing this form. Thank you for your gracious support.

Comments

Please provided us with any information that will help us process your sponsorship.