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The R.A.D. Charity
Date of Birth
ARE YOU CURRENTLY IN TREATMENT?
IF YES – WHY?
NUMBER OF CHILDREN
AGES OF CHILD(REN) ex.1,2,3
ARE ALL CHILDREN LIVING AT THE SAME ADDRESS?
IF NOT please indicate
WHAT AREAS OF ASSISTANCE ARE YOU LOOKING FOR?
BASIC NEEDS ex.(SHELTER, FOOD, SCHOOL SUPPLIES, OTHER)
COUNSELLING SERVICES (reasons)
ALL INFORMATION SUBMITTED TO RAD IS PRIVATE, we do not share any information with anyone not associated with RAD without your written consent.
Thanks for submitting the form to RAD, someone will be in contact within 3 to 5 buisness days.
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