Respite & COVID-19 Assistance | samanthaspurpose

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REQUEST FOR ASSISTANCE APPLICATION

Apply for Assistance

Assistance Needed: (mark all needed)

Groceries

Incontinence Supplies

Medical Supplies

Personal Hygiene Supplies

Respite Care

Financial Support with Therapy

Financial Support with Summer Camp

OTHER Assistance Request

I acknowledge that my personal information and application for assistance will be kept confidential. By submitting this application, I confirm that my information will be added to the organization's email list.

Thank You for your submission! We will be in touch with you shortly to discuss how we can assist you.

ABOUT US

Samantha's Purpose a/k/a Voices for Cerebral Palsy was co-founded by Manny & Michelle Garcia, in honor of their daughter, Samantha, who lives with Cerebral Palsy everyday.

CONTACT >

T: 305-345-4992

© 2020 by Samantha's Purpose, Inc.