1. No category


Please
complete
the
following
form
completely
to
refer
a
young
adult
to
Cinderella’s
Closet.
Referrals
can
be
made
by
high
school
counselor,
teacher,
principal,
social
worker,
or
clergy.
Send
completed
forms
to:
Mail:
Cinderella’s
Closet
of
Monmouth
County,
207
Old
Mill
Road,
Freehold,
NJ
07728
E‐mail:
ccmcoutreach@gmail.com
Saturday
March
21,
2015
Long
Branch
High
School
Referral
Deadline:
March
6th,
2015
Name
_________________________________________________________
High
School
__________________________________________________
Grade
_________________________________________________________
Approximate
Dress
size
_________
Shoe
Size_______________
Long
Branch,
NJ
Appointment
times
will
be
given
by
March
16h
at
the
latest.
Parental
Permission
I
authorize
my
daughter/son
to
participate
in
the
Prom
Boutique,
an
event
of
Cinderella’s
Closet
of
Monmouth
County,
so
that
she/he
can
obtain
a
prom
outfit.
I
also
authorize
Cinderella’s
Closet
of
Monmouth
County
to
photograph
the
event
and
use
those
photograph
for
their
brochures
and
website.
Name______________________________
Signature__________________________________________Date______________
Referral
Information
Name_______________________________
Title________________________________
School/Organization_____________________________________________________
Contact
E‐mail____________________________________________________________
You
will
be
contacted
with
appointment
time
via
e‐mail.
For
more
information
visit
our
website
www.cinderellasclosetmc.org