2024 RODF Toys Application for Registered & Actively Donating

Toy Giveaway Family and Group Home Registration Form.

The Toy Pick Up location will be 13558 Palm Street. Hesperia, CA 92344. (We will call you when it is time.)
🎄🎅 Please Note:
Our toy giveaway is based on donations, and while we truly want to provide a toy for every child, sometimes we may not have enough for everyone. 🎁 We do our best to give what we can, and we hope you understand if your bag has fewer items. Thank you for your kindness and understanding. 🎅❤️🎄
Person or Home filling out the form. (if home, please also list your name after.)*

First NameLast Name
Home name
Annual Household Income*
Making monthly donation*

YesNo
Contacts Phone Number*

Area CodePhone Number
Contacts E-mail Address
Family or Group Home Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Name of Child/Disabled Adult

First NameLast Name
Gender
Child/Adult Exact Pants Size With and Length
Does not mean they will receive clothes.
Child/Adult Shoe Size
Does not mean they will receive clothes.
What kind of board games do they like
Does not mean they will receive clothes.
Child/Adult Age
Child/Adult Shirt Size
Does not mean they will receive clothes.
Child/Adult likes
Please list some items they may enjoy.
Electronic Disclosure and Signature Agreement I know that any information given to Rock'n Our Disabilities will be protected and kept confidential. By entering your name on the signature line, you are signing this Application electronically. You agree that your electronic signature is the legal equivalent of your manual signature on this Application and is as valid as if you signed the document in writing. You also agree that the above information is correct and maybe verifiable. You further agree that your electronic signature grants Rock'n Our Disabilities the permission to confirm, where applicable, your income eligibility criteria and or the residential information entered on this Application.
Electronic Signature*
First and Last Name
DateTime
Should be Empty:

Toy Giveaway Family and Group Home Registration Form.