Registration Form

Operation Pedro Pan Group Registration Form

Please fill out as many as questions as you desire. The information will be kept confidential for the sole use of the organization. If anyone is searching for you, we will notify you to facilitate the reunification.

Name: First___________________________Maiden____________________Last_____________________
Home address:
Business address:
Telephone:
Home:_______________________Business:___________________Cell:________________
Fax:
E-mail address:
Profession/occupation:
Title:
Date of birth:
Place of birth:
Schools attended in Cuba:
Date of arrival and place in the US:
Did you come with other family or friends? Please give names.
Did you come through a third country?
Did you stay with friends or family?
Which camp did you stay in?
Place of residence at arrival:
Relocation/destination:
When were you reunited with your parents?
Personal comments or any other information you wish to contribute (you may use the reverse part of this page if you are going to mail this form).

Are you in touch with other Pedro pans from the camp days?
Are you trying to locate anyone?
If so, provide names.
May we give your name to other pedro pans that may be looking for you?______