Child Interest Form
(Homestudied)

Please enter name(s) of the Wendy’s Wonderful Kids in whom you are interested and provide your contact information below. (Items with * are required.)

Child's Name (or names, if siblings)

Child 1: *
Child 2:
Child 3:

Your contact Information:

Parent 1 Name (First, Middle, Last): *
Parent 2 Name (First, Middle, Last):

Mailing Street Address:       *
Mailing Street Address (2):
City: *
State / Province: * Postal / Zip Code: *

Home Phone Number: * (Include area code)
Parent 1 Daytime Telephone #:   (Include area code)
Parent 2 Daytime Telephone #:   (Include area code)

Your email address: *
 

Who completed your homestudy?

Agency Name: *
Social Worker Name: *
Agency Telephone Number: *
Date homestudy was completed: * (mm/dd/yyyy)
 

How did you learn about the Wendy’s Wonderful Kids website?

    *