FIRST RESPONDER Family Registration for W-A-T-C-H Program

***** FIRST RESPONDER Family Application *****

To Join W-A-T-C-H, please complete ALL information below. W-A-T-C-H (We Are The Children of Heroes) is a program for the children (and their surviving parent) of fallen first responders or families of fallen military who wish to support them. We host programs for children and widows/widowers of those men & women who have given their life while serving our communities as Police, Firefighters, EMS personnel.
Who Can Join:

FIRST RESPONDER FAMILIES: The widow/widower (or guardian) with children of a First Responder who was killed/died (post 9/11) while serving as a first responder, or who died from injuries sustained while serving as a first responder should complete the short below. Should you have questions, please send them to WATCH@22kill.com.
Please check to verify. We are the family of a:

Fallen FIRST RESPONDER
Parent / Guardian Information *

First Name Middle Name Last Name Suffix
Gender *
Date of BIRTH *

Month Day Year
Date
Email *
example@example.com
Mobile Phone Number *

Area Code Phone Number
Home Phone Number (if different)

Area Code Phone Number
Address *

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code

Children's Information
Name of Child # 1 *

First Name Middle Name Last Name Suffix
Child's Date of BIRTH *

Month Day Year
Date
Child's Gender *
Child's Age *
Child's favorite activities, subjects, or any development needs *
Such as: Music, art, hiking, fishing, camping, horses, science, reading, writing, poetry, etc
Name of Child # 2

First Name Middle Name Last Name Suffix
Child's Date of BIRTH

Month Day Year
Date
Child's Gender
Child's Age
Child's favorite activities, subjects, or any development needs
Such as: Music, art, hiking, fishing, camping, horses, science, reading, writing, poetry, etc
Name of Child # 3

First Name Middle Name Last Name Suffix
Child's Date of BIRTH

Month Day Year
Date
Child's Gender
Child's Age
Child's favorite activities, subjects, or any development needs
Such as: Music, art, hiking, fishing, camping, horses, science, reading, writing, poetry, etc
Name of Child # 4

First Name Middle Name Last Name Suffix
Child's Gender
Child's Date of BIRTH

Month Day Year
Date
Child's Age
Child's favorite activities, subjects, or any development needs
Such as: Music, art, hiking, fishing, camping, horses, science, reading, writing, poetry, etc
Name of Child # 5

First Name Middle Name Last Name Suffix
Child's Gender
Child's Date of BIRTH

Month Day Year
Date
Child's Age
Child's favorite activities, subjects, or any development needs
Such as: Music, art, hiking, fishing, camping, horses, science, reading, writing, poetry, etc

Fallen Hero's Information
Fallen Hero's Name *

First Name Middle Name Last Name Suffix
Hero's Gender *
First Responder Type
Cause of Death
Hero's Employing Agency *
EXAMPLE: Dallas Police Department, Texas Rangers,
Hero's End of Watch Date *

Month Day Year
Date
Badge ID#
Rank
Hero's Date of BIRTH *

Month Day Year
Date
Was this Fallen Hero a Military Veteran
If so, please list Branch of Service
How did you hear about W-A-T-C-H?
Name of person or group. Received information at meeting, etc.
Have a Question, please submit here. Thank You.
If you have a favorite photo of your hero alone or with you and family that you would like used to remember and honor his/her service and sacrifice, please attach/upload it to us here.

Attach & Upload Here
Click to attach Photo here. Don't forget to click SUMBIT below when you are done . By uploading the photo(s), I hereby grant permission for 22KILL / WATCH Program to use the photograph(s) and include it/them in their Heroes Honor Book, social media and publications, online, and in other communications related to the mission of honoring America’s fallen first responders and military. Cancel of
Should be Empty:

***** FIRST RESPONDER Family Application *****