Thank you for helping Nia House stay in touch with your children's grandparents!

Below there is space to provide the name, address, and email address for up t0 four grandparents or elders in your child(ren)'s life. 

Please do not put endearing names, Granny, Pa, etc. Rather, be sure to provide full names and addresses as shown below. 


Gerald and Jerry Washington

1234 Main Street

Oakland, CA 94602

Thank you for your help in this.

Child's Name *
Child's Name