Coast Guard Referral - Santa's Castle

Section 1: Service Member Being Referred

Fields with an * must be completed in order for the Santa's Castle team to process the referral.

Date Referred

Service Member Rank

Service Member First Name

Service Member Last Name

Service Member's Personal Email (DO NOT provide a .mil address.)

Service Member's Personal Phone Number

Service Member's Alternate Phone Number

List Unit

Location

Marital Status

Married

Single

Is the spouse Military or Non-Military?

Military

Non-Military

Spouse Rank

Spouse First Name

Spouse Last Name

List Spouses' Unit

Spouse's Personal Email (DO NOT provide a .mil address.)

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

Section 3: Referring Individual

Complete all information in this section for the Point of Contact for this referral.

Referrer Rank

Referring Individual First Name

Referring Individual Last Name

Referring Individual Email Address- MUST be an official military/.mil email.

Referring Individual Unit

Referring Individual Duty Phone Number

Referring Individual Cell Phone Number

Referrer Remarks

Electronic Signature of Referring Individual

I affirm that all information submitted is accurate to the best of my ability.

SANTA'S CASTLE COAST GUARD REFERRAL FORM

Section 1: Service Member Being Referred

Section 2: Dependent Children

Section 3: Referring Individual