Intake form

Help us serve you better

Name *

Email address *

What type of assistance do you need?

Please select at least one option.

Clothing

Hygiene Products

School Supplies

What is the age range of the children in need?

How did you hear about S.H.A.R.E.?

Do you represent a school or shelter?

What is your location?

How many individuals are in need of assistance?

Additional questions or comments

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