Virtual Santa Visit Request

Please fill out the felds on the form. If you would like to schedule appointments for multiple children, please complete one form for each child.

Parent/Guardian Name
OK Parent/Guardian Name is required
Email
OK Email is required
Phone Number
OK Phone Number is required
Child's Name
OK Child's Name is required
Child's Age
OK Child's Age is required
Child's Birthday
OK Child's Birthday is required
Child's Grade
OK Child's Grade is required
Child's Wishlist 1
OK Child's Wishlist 1 is required
Child's Wishlist 2
Optional OK Child's Wishlist 2 is required
Child's Wishlist 3
Optional OK Child's Wishlist 3 is required
Is there anything else we need to know to help make this visit extra special and/or encourage your child this holiday?
OK Is there anything else we need to know to help make this visit extra special and/or encourage your child this holiday? is required
Preferred time slot 1
OK Preferred time slot 1 is required
Preferred time slot 2
OK Preferred time slot 2 is required
OK is required

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