Name

School

Address

City State ZIP

E-mail

Date of Birth

T-shirt size (Adult sizes only: small, medium, large, x-large):

For teachers/group leaders only: Number of students who participated:

How many of each t-shirt size do you need?

Name of shelter or Organization you helped.

Describe in detail your fundraising event.

Describe in detail what you did to get the word out about your fundraiser.

What type of news media did you contact (newspaper, television, or radio)? Was your work publicized? If yes, tell us about the news story.

Total funds raised ($):

We'd love to see news stories about your project! Please send to kids@humanesociety.org or Humane Society Youth, 67 Norwich Essex Turnpike, East Haddam, CT 06423