Family Toy Request Form

Thank you for allowing Ayonna’s Safe Haven for Abused and Neglected Children to be part of your family’s holiday season.

At Ayonna’s Safe Haven, we believe every child deserves to experience love, joy, and the magic of Christmas. We understand that every family has unique circumstances, and we are committed to creating opportunities that bring comfort, encouragement, and hope to children and families in our community.

Our Christmas Program is made possible through the generosity of donors, community partners, volunteers, and individuals who believe in making a difference in the lives of children.

This application allows us to learn more about your household, understand your family’s needs, and determine how we may be able to provide assistance during the holiday season.

We ask that you complete this form carefully and provide accurate information. The information you share will help us administer our program, communicate with you, and coordinate available assistance.

By completing this application, I confirm that I am the parent or legal guardian of the child(ren) listed above, or that I have the appropriate legal authority to submit this application on their behalf.

I understand that Ayonna’s Safe Haven for Abused and Neglected Children collects information for the purpose of administering its Christmas Program and coordinating available assistance.

I certify that the information I have provided is true and accurate to the best of my knowledge. I understand that Ayonna’s Safe Haven may contact me to clarify information or request additional documentation when reasonably necessary to administer the program.

I understand that:

• Completing this application does not guarantee acceptance into the Christmas Program.
• Assistance is dependent upon available donations, resources, and program capacity.
• The organization may establish eligibility requirements for participation.
• The amount and type of assistance may vary from family to family.
• I may contact Ayonna’s Safe Haven if my circumstances change or if I need to update information.
• I am responsible for notifying the organization of any significant changes to the information provided.
• I should not submit information belonging to another person unless I have the authority to provide it.
• I understand that submitting false or misleading information may affect my eligibility for assistance.

 

 

At Ayonna’s Safe Haven for Abused and Neglected Children, we believe in celebrating the joy, hope, and positive impact created through our Christmas Program. We are grateful for the opportunity to serve children and families in our community and to share the meaningful moments that make these programs possible.

Throughout our Christmas Program activities, celebrations, and events, photographs and videos may be taken to document the program and highlight the importance of community support. These images may help us share our mission, recognize our supporters, and encourage others to join us in making a difference in the lives of children and families.

With your permission, Ayonna’s Safe Haven may use photographs, videos, or other media featuring you and/or your child(ren) for nonprofit purposes, including our organization’s website, social media pages, newsletters, promotional materials, fundraising campaigns, and other communications related to our mission and programs.

Your privacy and your family’s comfort are important to us. Participation in photography or media activities is entirely voluntary. Choosing not to give consent will not affect your eligibility to participate in the Christmas Program or receive assistance from Ayonna’s Safe Haven.

Before making your selection, please review the options below carefully. By selecting “Yes,” you are giving Ayonna’s Safe Haven permission to use photographs and/or recordings as described in this consent form. By selecting “No,” you are declining permission for photography or media use involving you and/or your child(ren).

Protecting the Privacy, Dignity, and Well-Being of Every Family We Serve

At Ayonna’s Safe Haven for Abused and Neglected Children, we believe that every child and family deserves to be treated with dignity, compassion, respect, and understanding.

We recognize that requesting assistance during the holiday season may be a difficult or personal decision for some families. We understand that families may be experiencing financial hardship, unexpected life circumstances, family changes, or other challenges that affect their ability to provide Christmas gifts and necessities for their children.

Our organization is committed to creating a welcoming environment where families feel respected, supported, and comfortable sharing the information necessary to participate in our Christmas Program.

We value the trust that families place in us. Protecting the personal information you provide is an important part of our responsibility as a community-based nonprofit organization.

This Privacy and Confidentiality Notice explains how Ayonna’s Safe Haven collects, uses, stores, and protects information provided through the Christmas Program application process.

Please read this notice carefully before completing and submitting your application.

1. Our Commitment to Your Privacy

Ayonna’s Safe Haven is committed to protecting the privacy of the children, parents, guardians, and families who participate in our programs.

We understand that information shared with our organization may include personal details about a household, contact information, children's names and ages, clothing sizes, gift preferences, and information about a family's circumstances.

We do not take the trust of our families lightly.

Our goal is to collect only the information reasonably necessary to administer the Christmas Program, coordinate available assistance, communicate with families, and maintain appropriate program records.

We strive to ensure that information is handled respectfully and that access is limited to individuals who have a legitimate reason to use it for authorized organizational purposes.

Our commitment includes:

• Treating every family with dignity and respect.
• Limiting the collection of unnecessary personal information.
• Taking reasonable steps to protect information from unauthorized access.
• Limiting access to authorized staff and volunteers who need the information to perform assigned duties.
• Avoiding unnecessary public disclosure of family circumstances.
• Providing clear information about how personal information may be used.
• Encouraging families to ask questions about privacy before submitting an application.

Our mission is to serve children and families—not to expose their personal circumstances.

 

2. Information We May Collect
To administer the Christmas Program, Ayonna’s Safe Haven may collect information that is reasonably necessary to review applications, communicate with families, and coordinate assistance.

Depending on the program's requirements, this information may include:

Parent or Guardian Information

• Preferred name
• Phone number
• Email address
• Mailing or residential address
• Relationship to the child or children
• Preferred method of communication
• Preferred language for communication

Child Information
Child's name
Age or date of birth
Gift preferences
Hobbies, interests, or activities

Household Information
Number of adults in the household
Number of children in the household
General information about household needs
Information necessary to determine program eligibility, if applicable

Program Administration Information
Application date
Application status
Assistance provided
Gift distribution information
Parent or guardian acknowledgments
Relevant communication records

Ayonna’s Safe Haven encourages families to provide only the information requested or reasonably necessary for the Christmas Program.

 

3. How We Use Your Information
Information provided through the Christmas Program application will be used for legitimate program-related purposes.

These purposes may include:

Application Review
We may use the information you provide to review your application and determine whether your household meets the requirements established for the Christmas Program.

Program Coordination
Information may be used to help our staff and authorized volunteers coordinate gifts, donations, supplies, and other forms of assistance.

Family Communication
We may use your contact information to:

Confirm receipt of your application.
Request clarification or additional information.
Provide updates regarding your application.
Notify you about gift distribution arrangements.
Communicate changes to program schedules.
Respond to questions related to your participation.
Recordkeeping
We may maintain appropriate records to document program participation, track assistance, evaluate program effectiveness, and meet legitimate organizational administrative requirements.

Program Planning
We may use information in a general or aggregated form to understand community needs, plan future programs, and improve services.

For example, we may review the number of children served or the number of families receiving assistance without identifying individual children or households.

Donor and Grant Reporting
Ayonna’s Safe Haven may need to report general program outcomes to donors, grantors, or community partners.

When reporting program impact, we will strive to use general statistics and non-identifying information whenever possible.

We do not need to share a family's personal story or a child's identity simply to demonstrate that our Christmas Program made an impact.

4. Information We Will Not Publicly Share Without Appropriate Permission

Ayonna’s Safe Haven respects the privacy of participating children and families.

Unless there is an appropriate legal basis or permission, we will not intentionally publicly share personal information such as:

• A child's full name.
• A child's personal circumstances.
• A family's private financial information.
• A family's residential address.
• A parent's or guardian's personal contact information.
• Details about a family's hardship or trauma.
• Information that could unnecessarily identify a vulnerable child or family.
  We understand that a family may want to receive assistance without having their personal circumstances shared with the public.

Receiving Christmas assistance does not require a family to share its story publicly.

Information About Children

Children are at the center of Ayonna’s Safe Haven’s mission, and protecting their privacy is one of our highest priorities.

We recognize that children may be especially vulnerable to unwanted publicity, disclosure of personal information, or exposure of private family circumstances.

When collecting information about children, we will seek to limit the information to what is reasonably necessary for the Christmas Program.

We encourage parents and guardians to avoid including unnecessary personal details about a child's history, health, family circumstances, or other sensitive matters.

Protecting Children's Information
Ayonna’s Safe Haven will strive to:

• Limit access to children's information.
• Avoid unnecessary public identification of children.
• Use child information only for authorized purposes.
• Avoid sharing children's personal stories without appropriate permission.
• Use care when collecting photographs or videos.
• Respect a parent's or guardian's stated media preferences.
• Take reasonable steps to prevent unauthorized disclosure.

If a child has special privacy or safety concerns, we encourage the parent or guardian to inform an authorized program representative so that appropriate arrangements can be considered.

Who May Have Access to Your Information?
Access to application information will be limited to individuals who need it for legitimate program-related responsibilities.

Depending on their assigned duties, this may include:

Authorized Ayonna’s Safe Haven Staff
Staff members may need access to review applications, communicate with families, coordinate assistance, or maintain program records.

Authorized Volunteers
Certain volunteers may need limited information to help prepare gifts, organize donations, or assist with distribution.

Volunteers should only receive the information necessary to complete their assigned responsibilities.

Authorized Program Partners
In some circumstances, Ayonna’s Safe Haven may work with community partners or service providers to coordinate program activities.

Information should only be shared when reasonably necessary, appropriately authorized, and consistent with applicable privacy requirements.

Service Providers
The organization may use third-party services for tasks such as application processing, document storage, communication, or record management.

Where applicable, the organization should take reasonable steps to ensure that such providers handle information appropriately.

Not every staff member, volunteer, donor, or community partner will have access to every family's information.

Your Responsibility as a Parent or Guardian
Parents and guardians also play an important role in protecting family information.

When completing the Christmas Program application, we ask that you:

• Provide accurate information.
• Share only information necessary for the application.
• Avoid including unnecessary sensitive details.
• Notify the organization if your contact information changes.
• Keep copies of submitted documents in a secure location.
• Ask questions if you do not understand how information will be used.
• Inform program staff of any special privacy or safety concerns.

If you believe information has been shared improperly, please contact Ayonna’s Safe Haven so the concern can be reviewed.

Questions, Concerns, or Privacy Requests
We want families to feel comfortable asking questions about their information.

If you have questions about this Privacy and Confidentiality Notice, you may contact Ayonna’s Safe Haven for assistance.

Organization Contact Information
Ayonna’s Safe Haven for Abused and Neglected Children

Website: www.ayonnassafehaven.org

Email: info@ayonnassafehaven.org

Phone: 314-850-9643

Privacy Contact or Program Representative: Paris Jones

By signing below, I acknowledge that I have received and reviewed the Privacy and Confidentiality Notice for the Ayonna’s Safe Haven Christmas Program.

I understand that the organization collects information for legitimate program-related purposes and that reasonable steps will be taken to protect the information provided.