SANTA'S CASTLE MARINE REFERRAL FORM
Marine Referral
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Service Member Info
Continue to Dependent Children
Date Referred
Service Member Rank
Service Member First Name
Service Member Last Name
Service Member Unit
Location
Service Member's Personal Email (DO NOT provide a .mil address)
Service Member's Personal Phone Number
Service Member's Alternate Phone Number
Marital Status
Married
Single
Is the spouse Military or Non-Military?
Military
Non-MIlitary
Spouse First Name
Spouse Last Name
Spouse Rank
List Spouses Unit
Spouse's Personal Email (DO NOT provide a .mil address)
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Continue to Dependent Info
Section 2: Dependent Children
Accurate information on the SM's child(ren) helps us ensure we have appropriate inventory.
Infants (0-12 months)
Boys: Total in each age group
Boys: 1-2 yrs
Boys: 2-3 yrs
Boys: 3-5 yrs
Boys: 6-9 yrs
Boys: 10-13 yrs
Boys: 14-18 yrs
Girls: Total in each age group
Girls: 1-2 yrs
Girls: 2-3 yrs
Girls: 3-5 yrs
Girls: 6-9 yrs
Girls: 10-13 yrs
Girls: 14-18 yrs
Special Needs Children
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Continue to Referring Individual
Section 3: Referring Individual
Complete all information in this section for the Point of Contact for this referral.
Referring Individual Rank
Referring Individual First Name
Referring Individual Last Name
Referring Individual Email - MUST be an official military/.mil email.
Referring Individual Unit
Referring Individual Cell Phone Number
Referring Individual Duty Phone Number
Referrer Remarks
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Continue to Verification and Signature
Electronic Signature of Referring Individual
I affirm that all information submitted is accurate to the best of my ability.
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