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Binky Patrol Comforting Covers for Kids
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Teen/Student/Children's Sign Up Form

Welcome to Binky Patrol,

We are asking that if you want to have Binky Patrol as your community service project, Scouting award project or club project that you fill out this form below.

If your entire class, troop or school is participating, please just have the advisor or principal fill out one form.  We've had schools of over 500 join us, we would hate to see 500 forms come through..... Thanks!

The information you give us will not be given out to anyone.  We just want to make sure that your parents/teachers/advisors know that you are volunteering for our organization and that it is OK by them.

Your first and last name *

Your age *

Your City *

Your State *

Your email *

A Parent/Gaurdian/Teacher/Leader's Name *

The phone number of the adult named above. *

What is their relation to you? *

Do they know you are volunteering to help? *

 yes
no

How do you want to help Binky Patrol? *

 Make binkies
Help deliver binkies
Start a chapter
Get my friends involved
Bring this project to my school
I'm not sure -- contact me.
 

* These are required fields

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