ST KIDS CLUB
Membership Form

Childs Name:*

Childs School:*

Parent/Guardians Name:*

E-mail Address:*

Parent/Guardians Address:*

City:*

State:*

Zip:*

Does your child participate in the Fannie Mae Help the Homeless Mini Walk ?

Yes

Would you like to receive Shepherd's
Table's E-newsletter?

Yes

* Required fields

	©2007 Shepherd's Table \| 8210A Colonial Lane \| Silver Spring, Maryland 20910 \| 301-585-6463 \| fax 301-585-4718 info@shepherdstable.org