The Hope For Haiti's Children Inc.              Sponsorship Form

Name of child being sponsored: ___________________________________ Age of child:__________     I agree to the Terms of Agreement. Name:_________________________________________________________________                                              (first and last) Address:_______________________________________________________________ State or Province:______________________________________________________________ Country:_______________________________________________________________ Zip or Postal Code:______________________________________________________ Phone (optional):________________________________________________________ Email (optional):______________________________________________________________               Please make your checks payable to Hope for Haiti's Children Inc.                        Please print out this form and send it with your check to:                                         Hope For Haiti's Children Inc.                                                c/o Cynthia Khawly                                            16477 SW 100th Terrace                                                Miami, Florida 33196                                                           U.S.A                                                       Thank you!

Yes, I would like to sponsor a child by donating : (check one please) per month to  Hope For Haiti's Children Inc. to provide the needs of poor Haitian children.

$5

$10

$15

$20

Other:$______

I prefer that my child is selected for me instead.