2025 Christmas Nomination – Shop With a Caregiver

2025 Christmas Nomination – Shop With a Caregiver
CHRISTMAS NOMINATION FORM

We’re accepting nominations for four individuals of ages 5+ to receive a $100 Christmas Shopping Experience sponsored by Destiny’s Caring Hands LLC. One nomination per household. Incomplete forms are not accepted.
Section 1: NOMINATOR INFORMATION
Full Name*

First NameLast Name
E-mail*
example@example.com
Phone Number*
Your Relationship to Nominee (or self)
County of Residence
Section 2: NOMINEE INFORMATION
Nominee Full Name

First NameLast Name
Nominee Age
Nominee Phone or Guardian Phone
Please enter a valid phone number.
Nominee Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Does the nominee have reliable transportation?

YesNo
Why are you nominating this person?
Is the Nominee currently receiving holiday assistance from another program?

YesNo
Section 3: How Did You Hear About Us?
How did you hear about this Christmas program?
Section 4: Agreement

Please read and acknowledge the following terms before submitting your nomination:
Please check to acknowledge and agree:

I understand that submitting this nomination does not guarantee selection for the Shop With a Caregiver program.I understand that only four individuals will be selected this year, and submitting multiple entries may result in removal to ensure fairness.I confirm that all information provided in this nomination is accurate and truthful to the best of my knowledge.I understand that this program is intended for individuals or families experiencing need during the holiday season.I understand that a valid ID will be required at pickup or at the scheduled meeting time if the nominee is selected.I acknowledge that Destiny’s Caring Hands LLC cannot guarantee specific shopping locations, schedules, stores, or personal accommodations.I agree to maintain respectful communication with all Destiny’s Caring Hands LLC staff, volunteers, and community partners.I understand that failure to respond to a confirmation message within the required timeframe may result in forfeiture of the spot.I understand that selected individuals will receive a confirmation email containing instructions, scheduling information, and next steps.
Photo Consent & Usage

I understand that Destiny’s Caring Hands LLC may request or collect a photo of the nominee for identity verification and program documentation.I give permission for Destiny’s Caring Hands LLC to use the nominee’s photo, first name, and submitted story for marketing, website content, social media, and community outreach purposes if the nominee is selected.I understand that Destiny’s Caring Hands LLC will not sell or misuse any photo or information submitted and will use it only to highlight community programs, events, and positive outreach.I confirm that I have the legal right to submit the nominee’s photo and grant permission for its use as stated above.
Communication Consent

I understand that Destiny’s Caring Hands LLC may contact me regarding nomination updates, confirmation details, pickup reminders, or future community resource events.
Section 5: Signature & Submission
Signature

Clear
Date
Should be Empty:

2025 Christmas Nomination – Shop With a Caregiver

CHRISTMAS NOMINATION FORM

Section 1: NOMINATOR INFORMATION

Section 2: NOMINEE INFORMATION

Section 3: How Did You Hear About Us?

Section 4: Agreement

Section 5: Signature & Submission