Ink Well Pen Pals Request Form

Ink Well Kids Pen Pals Request Form

If you are the Official Guardian* for a child who is facing serious illness or home-life hardship such as neglect, abuse, or foster care, you may apply here to have a special artwork made just for them. We will do our best to find an artist from the child's favorite book, film, or TV show to create a tailor-made drawing then will mail it straight to them.

*To be an Official Guardian, you must have legal authority over this minor. An Official Guardian is usually a biological parent or court-designated guardian.

You will be asked to provide a doctor's note or other official documentation that confirms the child's condition. The doctor or a support-care facility must be currently operational. We must ask this of all applicants in order to confirm eligibility and prevent abuse of the program. Any information we receive will be kept completely confidential.

Full Name*

Phone*

Email*

Relationship to Minor*

I declare that I am an Official Guardian for this child.*

Full Name*

Age (must be under 18)*

Please describe the challenge this child is facing.*

In order of preference, what are the child's top three favorite books, cartoons, and/or films?*

Anything else we should know?

Address the artwork should be mailed to:*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Permission to Share

For approved applicant's, we would appreciate the chance to share through a brief description and photo of the child with the artwork they receive from the Ink Well Kids artist. This helps us spread the word about the Pen Pals Program to other kids and also lets the children we serve see that they are not alone in facing their challenges.

This is not a requirement to participate but if you grant permission, we will reach out to you to discuss further. Please mark your preference below:

I grant to Ink Well Kids Foundation the right to use the name, likeness, and biography of the applicant to share about its charitable activities in perpetuity.*

I agree.I do not agree.

Your Information

Child's Information