SAFE SPACE REQUEST

Submitter Name(Required)

First Last

Submitted Phone(Required)

Submitted Email(Required)

Facility/Organization Name(Required)

Please select from the list below(Required)

If other, please specify

Location address

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code

Request type

Hygiene and other essential items

Activity Baskets (Choose from Movie Night, Game Night, or Painting Night)

Please describe your facility’s needs (e.g., hygiene items, clothing, baby products)(Required)

Estimated number of foster youth served(Required)

Frequency of Needs(Required)

One-time

Ongoing

Preferred Delivery Date(Required)

MM slash DD slash YYYY

Do you have storage space for supplies?(Required)

Yes

Are you able to pick up supplies if delivery isn’t possible?(Required)

Yes

Select an Activity Basket

Movie Night Basket (includes popcorn, snacks, and a family-friendly movie rental voucher)

Game Night Basket (includes board games, card games, and snacks)

Painting Night Basket (includes painting supplies, canvases, brushes and more)

Preferred Event Date (2 week notice)(Required)

MM slash DD slash YYYY

Do you have space to host the activity?(Required)

Yes

Would you like FFC volunteers to help facilitate the event?

Yes

I understand that all requests are subject to resource availability and funding.

I agree to provide feedback on how the supplies were used to benefit the youth we serve.

I agree to send pictures!

Signature(Required)

Date(Required)

MM slash DD slash YYYY

Phone: 407.422.4615 | Fax:
2265 Lee Rd Suite 203, Winter Park, FL 32789
Email: info@foundationforfosterchildren.org