Adopt a Family

Sponsoring Organization:
Corporate Sponsor or Donor:
Adopted by:  
Name of Department:
Point of Contact:
Complete Mail Code:
Complete Telephone #:
Secondary Telephone #:
Client Last Name:
Street Address:
City & State:
Apt:
Zip:
Nearest Cross Streets: &
English Spoken?
Family Culture
Time At Home:
Family Members
Family First Names
Age
Sex
Basic Needs
1.
2.
3.
4.
5.
6.
7.
8.

I hereby give permission for the above information to be shared why the donor, if one is found. I understand that the donor May or May Not include other gifts as well as food. Used Clothing is O.K.

I agree to a family photo for Parent Help records.

I have attended parenting classes this month.
We need transportation to parenting classes.
I agree to and understand that some personal confirmation on my family will be shared with a donor or corporate sponsor.
Food and clothing could also be included with Christmas toy delivery.
Is there one or more families living at this address.