Contact Name:
Organization:
Street:
City:
State:
Zip:
Day Phone:
Evening Phone:
Cell Phone:
Fax Number:
Email Address:

Because of several entering requests for a particular family at the same time, please give us 3 choices of families.  It is assigned on a first-come, first-serve basis ...
thank you for understanding.
1st choice family to Adopt:
1st choice family ID #:
2nd choice family to Adopt:
2nd choice family ID #:
3rd choice family to Adopt:
3rd choice family ID #:
Additional Comments:

Please fill out this form as complete as possible.  You will be notified with all the information regarding this family and how to get their care package to them.
SPECIAL NOTE!

Please do not fill out this form if:

1)  You are not serious about adopting a family and sending a care package.

2)  You are looking to find someone to date or marry.  This is to help those in need, not to find a partner.

3)  You are just playing on-line and have nothing better to do.

This website is to help those in need of assistance ... and for those SERIOUS about helping others.  Thank you.

updated 06/08