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Refer A Child Form

Referrer Details
Your First Name *
Your Last Name *
Your Email *
Phone
Relationship to Referee *
Amputees Information:
Child's First Name *
Child's Last Name *
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Age of the Referrer *
Country
City, State *
Please share the story of the person with us *
Lets take it up from here.
Please share the Child's Parents/Guardian's details
Phone
​
Do they have an Internet-enabled phone?
​
Can they speak and read in English?
​
Do they have an active Email Address?

The IREDE Foundation Refer A Child Form

Hi There! Thank you for choosing to refer a Child Amputee. We are so grateful for your desire to help child amputees across Africa, helping them live independent and limitless lives by.

Please fill the details of the child you are referring so that we can reach out to them.
** Be assured that any information you share with us will be kept confidential and protected in line with our data protection policy.

Thank You once again. The IREDE Foundation