Child Sponsorship Online Form
Child Information
Reference Number:*  
Name of Child:*  
Village/House*  
Date of Birth:*  
E-Mail
Important: Enter a valid e-mail address. Receipts will be sent to this address.
E-Mail:*  
Billing Information
First Name:*   Same name as on your card
Middle Initial:  
Last Name:*  
Address Line 1:*   Where your statement is mailed
Address Line 2:   Apt. or Suite No.
City:*  
State:*  
Zip Code:*  
Phone:*  
Sponsorship Information
Sponsor a Child:  
  Monthly $25.00  
Sponsor a Child:  
  Annually $300.00  
Sub-Total:  
 
Additional Donation:  
Grand Total:  
 
Credit/Debit Card Information
Card Number:*   No dashes or spaces please
Expiration Month:*   From your card
Expiration Year:*   From your card
Card Brand:*  

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