LforKidsForm

NOTICE: THANKS TO THE GENEROSITY OF SHOOK, HARDY AND BACON, THE LAWYERS FOR KIDS PROGRAMS IS FULFILLED DOZENS OF WISHES FOR THE CHILDREN OF OUR MEMBERS. THE PROGRAM HAS REACHED CAPACITY FOR THIS YEAR. LAWYERS FOR KIDS WILL BEGIN TAKING NEW REQUESTS IN JANUARY 2009. PLEASE CONTACT US AT THAT TIME.

Lawyers for Kids, Wish Fulfillment Request

Please fill out every field of the request form. Incomplete requests will not be processed.
This program is available to children 3-19 yrs old, living in a confirmed foster/adoptive or kinship home.
$500 wish limit (referring source should not share the dollar amount with the child).
Limited to children in Jackson County, or children who are from Jackson County but currently placed elsewhere.
Transportation must be available. Transportation is not included in Wish Fulfillment.
A Separate form MUST be completed for each child, even if the wish is the same for multiple children.
Wishes will normally be fulfilled within 60 days of request date. If a child's wish is seasonal or time-sensitive, please note this under "additional wishes".
Wishes are fulfilled on first-come, first-served basis. Priority is given to wishes that enhance skill development or leadership skills.
No gun-training, paintball lessons, fencing, shooting, or weaponry of any kind. No Pets. No video games or electronics, unless there is a special need.
Foster/adoptive family, case worker, adoption recruiter, CASA, or GAL is responsible for identifying and securing transportation necessary for fulfillment of wish.
One wish per child, per year, may be submitted.
Questions? Please email Suzen or call her at 816-350-0215

If you do not receive a response to your submission within one week, please contact us.

Child's Information

First Name:
Last Name:
AKA:
Date of Birth:
ID #:

Placement Type: Birth Relative Foster Group Care Independent Living Adopted
Ethnicity (please check all that apply): African American Caucasian Asian American Hispanic Native American Other
Gender: Male Female
Legal Status: (Guardianship - must be a DCFS Ward)
Referring Source: Case Manager Adoption Worker Foster Parent Relative Parent/Adoptive Parent Other
Caregivers Name:

May MFCAA contact you? Yes No
Your Information

Name:
Address:
City:
State:
Zip:
Email:
Home Phone:
Office/Cell Phone:
Fax Number:

Adoption Worker:
Agency:
Phone Number:
Fax Number:
Email Address:

Please enter the request you are making (the wish to be fulfilled). In order to be considered, the wish must meet the requirement outlined above.

Why is the child requesting the above wish?

Cost:

Has the family asked about reduced fees or scholarship opportunities for foster adoptive families, that pertain to the wish?

Indicate preferred vendor name and information:
Vendor:
Address:
City:
State:
Zip:
Phone:

Who will provide transportation:

Any additional information?

Required Signatures and Statement of Release:

By Choosing to Submit this form, and clicking the "Submit" button below, you agree that:
MFCAA does not make reimbursements to individuals. All checks are made payable directly to the vendor. I authorize the MFCAA to provide this service: no state funding or other resources are available to fund this child’s request. The Undersigned hereby releases and discharges the MFCAA and it’s employees, agents, and related companies from all liability and any and all manner of action or actions, causes or causes of actions, including, but not limited to negligence, suits, legal fees, damages, claims and demands of whatsoever in law or in equity or otherwise, which s/he may have or may acquire by reason of any injury, damage or harm to the participants while participating in said program, arising out of, or connected with, participation in said program: and The undersigned understands that the MFCAA and its employees, agents and related companies accept no responsibilities if the program is cancelled. This consent and waiver will not be made the basis of a future claim of any kind against MFCAA and any of its employees, agents or related companies.

THIS FORM IS INACTIVE UNTIL JAN. 2009