ECOLE LE BON SAMARITAIN
THE GOOD SAMARITAN SCHOOL

SPONSORSHIP FORM

SPONSOR INFORMATION

I am interested in sponsoring a:

Boy

Boy or Girl

Girl

Teacher

My help will cover:

Tuition

Lunch

Health Care

Volunteering

Books

Clothing

Transportation

Summer Camp

I will forward the amount of:

Check

Money Order

DONATION

I wish to make a one time donation instead for the amount of:

Money Order

in the form of a:

Check

SPONSOR'S INFORMATION

Name:

Address:

City:

State:

Zip:

Country:

E-mail:

REFERRAL

Also send information to my friend at the following address:

Name:

Address:

City:

State:

Zip:

Country:

E-mail:

Thank you for sponsoring a child. Your donation will help us provide for a needy child.