Client Application

All information must be filled out to the best of your knowledge. If you have the documentation already scanned please email it with your first and last name as the subject to info@babyjamesfoundation.com Further documentation or information may be asked after reviewing your application. Each application is taken into concideration on an individual bases and although we ask for certain information and you may not have it does not mean you will or will not be approved. Not just one individual makes the decission it is voted on. Sometimes we will help you find the help you need for what you need within other organizations. Honesty is the best in the application process. The main requirement in this process is that the child is a victim of abuse. Some situations take a longer process then others. After application is received a copy will be sent to you to sign and mail back to our foundation. Please read the letter attached carefully to see if anything further is needed for your to send back with your application. Once we receive the original application in email we will start making our decission; although nothing will be final till we receive signed application and all documentation back from you.

Thank you

Baby James Foundation

 

    First Name: *
    Last Name: *
    Address: *
    City: *
    State: *
    Zip: *
    Phone Number: *
    Cell Number:
    E-mail Address: *
    Best Time to Reach You: *
    Morning
    Afternoon
    Evening
    Night
    Name of child *
    Birthdate of child *
    Age of child (If deceased age at time of death) *
    Is child deceased *
    Yes
    No
    If no, does the child live with you *
    Yes
    No
    If child is deceased funeral home, preacher, cemetary, and etc. information. Including address, office, and/or any other information you can give us
    Are you legal guardian of this child *
    Yes
    No
    If you are not legal guardian who is and please explain in details why they are, address, phone and any other information you can give.
    Explain in detail what assistance you are needing *
    If this is a bill please provide us with name, address, ammount, etc of bill. Money will be paid directly to the company
    Do you have any kind of verification that this is a child abuse case *
    Yes
    No
    If you can not verify by documentation how can you verify that this is a child abuse case
    Can you supply a birth certificate of the child *
    Yes
    No
    If not explain why cant you supply a birth certificate. Also include hospital name, city, state, and county of birth.
    Can you supply death certificate if child is deceased
    Yes
    No
    If you cant supply a death certificate please give city, state, county, hospital that death took place. Also, explain why you cant supply a copy
    Have you received any other assistance for this need by any other organization? (This does not mean you will not receive if you have but please be honest) *
    Yes
    No
    If so who has helped you? Include name, address, phone number, how much they have helped with.
    Who was the person that did the abuse (full name and relationship) *
    As hard as this is we need detailed description of the abuse *
    Do you want media to contact you regarding any media attention with Baby James Foundation? Please understand you do not have to agree with any of the media attention questions. *
    Yes
    No
    Do you agree to any media for Baby James Foundation *
    Yes
    No
    Do you want your childs name public. Pick from box which you agree to. *
    Do you want your childs picture public *
    Yes
    No
    I certify that, to the best of my knowledge, all information supplied by me is true. If you agree type your full name below and relationship to child. *
    Date *
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