ADOPT A FAMILY FORM

Parent Name:*

First Name Last Name

Address*

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code

Email Address:*

example@example.com

Phone Number:*

Please enter a valid phone number.

How many Children are in the home?*

Child Name One:*

First Name Last Name

Female   Fe Male*

Child Age: Age*     Child Coat Size:   Age*
Child Shirt Size: Shirt Size* Child Pants Size: Pants Size*
Child Shoe Size:  Shoe Size*

List Three Wish List Items this child would like: Three Items*

Child Name Two:

First Name Last Name

Female   Fe Male

Child Age: Age     Child Coat Size:   Age
Child Shirt Size: Shirt Size Child Pants Size: Pants Size
Child Shoe Size:  Shoe Size

List Three Wish List Items this child would like: Three Items

Child Name Three:

First Name Last Name

Female   Fe Male

Child Age: Age     Child Coat Size:   Age
Child Shirt Size: Shirt Size Child Pants Size: Pants Size
Child Shoe Size:  Shoe Size

List Three Wish List Items this child would like: Three Items

Child Name Four:

First Name Last Name

Female   Fe Male

Child Age: Age     Child Coat Size:   Age
Child Shirt Size: Shirt Size Child Pants Size: Pants Size
Child Shoe Size:  Shoe Size

List Three Wish List Items this child would like: Three Items

Are the parents or is the child(ren) deaf or hard of hearing?*

YesNo

If the parents or if the child(ren) are deaf, which one are deaf or hard of hearing?*

Parent(s)Child(ren)

Child Name Five:

First Name Last Name

Female   Fe Male

Child Age: Age     Child Coat Size:   Age
Child Shirt Size: Shirt Size Child Pants Size: Pants Size
Child Shoe Size:  Shoe Size

List Three Wish List Items this child would like: Three Items

Why Should the Abram Powell Foundation Adopt this family for Christmas?*

Have any of the child(ren) parents been incarcerated in Federal Prison or is currently in Federal Prison?

YesNo

If one of the child(ren) parents has been to Federal Prison, please upload proof (Documents from the Federal Institution showing that one of the parents have just been released from Federal Prison within the past 12 months or upload the BOP form from online that shows one of the parents are still currently incarcerated in Federal Prison).

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If the family you recommended is selected, a videographer and photographer will be present to film with one of the Abram Powell Foundation team members dropping off the Christmas gifts to the family that has been selected. This footage is used to help raise additional money for the following year to help families in need at the Abram Powell Foundation. Will this family be okay with the Abram Powell Foundation capturing this Christmas scene? If the family will not be okay with the Abram Powell Foundation capturing this Christmas scene this family may not be recommended to be a part of the "Adopt a Family" Christmas Program.*

YesNo

Person Recommending the Family:*

First Name Last Name

Email Address:*

example@example.com

Phone Number:*

Please enter a valid phone number.