Adopt-a-Child or Family Program
Human Services Department administers our holiday program to low-income families by providing gifts and funds to support them in celebrating their holidays season. This year we are supporting families through our Adopt-a-family program. Those interested in buying gifts for children or a family, please complete this application.
Name
*
First Name
Last Name
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Email
*
example@example.com
What is the best contact method?
*
Phone
Email
Please indicate how many children or family you would like to support?
*
I would like to support 1 child
I would like to support 2 children
I would like to support 3-4 children
I would like to support a small family (1 adult, up to 3 children)
I would like to support a medium size family (2 adults, up to 4 kids)
Other
Any additional information you would like to add?
Every year we recognize all of the individuals, families and business that donate and support our program. Please indicate one of the following:
*
I would liked to be recognized
I would like to remain anonymous
If you chose to be recognized, please let us know how you would like your name to be displayed:
Submit
Should be Empty: