Kid's Cup Referral Form

If you know of a child or family in need, please complete the form below so that we may connect them with the resources they need. We accept referrals from social workers, therapists, counselors, teachers, and other service providers. If there are special circumstances we should consider, please email or call us directly. janice@kidscupcloset.org | 478.290.8871 When you submit the form below, we will send a referral certificate to both you, the referring agent, as well as the children's guardian. This certificate may then be presented at the time of appointment electronically or printed. Please notify the guardian that once they have the referral certificate they may reach out to us directly to schedule an appointment at 478.290.8871 or janice@kidscupcloset.org.

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Please provide any information you are able to share. ex. Name, Age, Gender