sk8shoes4kids.org referral form

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Approved

Date:

CRITERIA: This program is designed for children and youth 18 yrs. & under who cannot otherwise afford shoes due to financial means.Those that apply will not have a choice of shoe but will be given new name brand skate shoes.

Self Referral

Professional Referral

Name:

Age:

Contact #:

Shoe Size:

Explanation of how you/individual qualifies for shoes:

All information is confidential, unless you/individual signs a release of information form. All applications can be dropped off at Freedom Quest 349 Columbia Ave., Castlegar Phone 250-304-2676 for more info.

FREEDOM QUEST

Regional Youth Services

Street Dreamz Boardshop Inc. 7923 120th Street, Delta B.C. CANADA Phone: 604 - 590 - 4553 Email:streetdreamz@hotmail.ca


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