Printable version of form

SHAMA Inc Kids Program

Yes! I want to sponsor a child!

_____ Child's code number. Please include all the digits of the code number, even if it begins with a zero. (If you have no preference of which child to sponsor, leave this blank.)

Please check the amount you can pay


I can contribute $10 a month


I will pay for an entire year now ($120)


If you wish to contribute a different amount, please record that amount in the blank to the left.

Please check your preferred payment option below:


I will pay by check now (Make checks payable to "SHAMA Inc Kids")


I will pay by check by this date: _______________________ (Make checks payable to "SHAMA Inc Kids")


I would like to arrange monthly sponsorship by direct deposit to the SHAMA Inc Kids bank account from my bank. For more information about this, email


I will pay by credit card. (For information about how to do this, go to our web page at

Contact Information:







Phone number w/ area code

OR Email address  

Mail this form to:

Jagdish Chander, for SHAMA Inc Kids
2460 Crescent Court
Plover, WI 54467

Note: Sponsorship cannot begin until SHAMA Inc Kids receives the first payment.