Spinoza Bear ~ the Bear Who Speaks from the Heart!

Parent or Guardian Enrollment Form

Dear Parent or Guardian,

Spinoza's "buddy bear project" was created for children and families of the US who are facing the challenges of coping with a chronic illness. Through the generosity and caring of community service organizations, Spinoza may become a part of your child's life, providing loving messages, comfort and support.

The sponsorship process can take from two weeks up to two years. Although our wish is for every child to have their own Spinoza Bear as soon as possible, we cannot guarantee that a sponsor will always be found.

Complete the information listed below regarding your child. This is the only information given to a potential sponsor.

Please enter your child's information:

First Name
Date of Birth
Diagnosis
Sex	Male Female

Please provide the following parent or guardian information:

Name
Relationship to Child
Shipping Address (no PO Boxes)
Address (cont.)
City
State
Zip/Postal Code
Work Phone
Home Phone
Fax
E-mail
Personal delivery by sponsor is ok
Your Website Address

© 2002-2006 The Spinoza Company
PO Box 97 Cornucopia, WI 54827
Tel: 1-800-282-2327 • Fax: 651-604-6681