Sponsor Form

4 Kenya’s Kids Sponsorship Registration Form
Today's Date

MonthDayYear
Date
Full Name*

First NameMiddle NameLast Name
Current Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Email Address*
Phone Number

Area CodePhone Number
Please provide name(s) of child or children you will be sponsoring
Please check method of payment

Check mailed MonthlyCheck mailed QuarterlyCheck mailed BiAnnuallyCheck mailed AnnuallyAutomatic Withdraw
*Please fill out information on next page for automatic withdrawal
4KenyasKids EFT Authorization Form- NAC Client I

Automatic Transfer Authorization Withdrawal Information
Month to begin withdrawals
Type month
Day of month for withdrawal each month

1st of month15th of month
Withdrawal Amount:
$60 monthly per child grade Preschool thru grade 6
$75 monthly per child grade 7 thru 12
$100 monthly per child for higher education
Type the total amount you authorize 4KenyasKids to withdraw each month:
As a convenience to me, I authorize my bank, named below, to withdraw funds from my account. I understand that I remain in full control of my transactions and that this method of donation may be stopped at any time. Any changes in the monthly contribution can be made by contacting 4KenyasKids at 4kenyaskids@gmail.com or by writing to:
4KenyasKids,
P O Box 643,
New Haven, IN 46774
Please complete Account Information on next page:

4 Kenya’s Kids Sponsorship Registration Form