One Time Donation Customer Info Payment Info Card Info Contact Info "It made me look at things way differently than I did before. I could definitely say that this program has helped me in many different areas like containing my anger and trying not to make decisions I don’t want to make" —Referred Youth First Name Last Name Billing Address Billing Address 2 City State Zip Email Contact Phone Payment $50—refreshments for one month of conferences$100—fee waived for one adult with financial hardship$250 —One youth community conference$500—One community gathering of "Messy Conversations: Understanding and Addressing Implicit Bias" Amount 25 50 100 250 Other Other Amount Credit card Review and Confirm "It helped me to have the tools to help my son make better decisions and that I can accomplish so much more with the right mindset and surroundings."—Parent Name: Address: City/State/Zip:, Card: ending expiring Amount:$ TERMS AND CONDITIONS: I authorize Restorative Justice Community Action, INC to charge the amount listed above to the credit card provided herein. I agree to pay for this purchase/donation in accordance with the issuing bank cardholder agreement. Comments/Message to RJCA Donation Successfully Processed "I think this program is the driving force behind the healing that has to take place to allow the community members to engage the community again."—Community MemberTHANK YOU for your support.