RAINE Holiday Help Registration

RAINE Holiday Help Registration

By filling out this form you are requesting help from the RAINE Foundation for the holidays. You must fill out all fields that are marked as required with the red *. When filling out fields with open text be as specific as possible. Deliveries may not be possible and resources may be limited so please keep that in mind as you fill out the form.
Family Information
First Name
Last Name
Email Address
example@example.com
Mobile Number
Please enter a valid phone number.Format: (000) 000-0000.
Street #
Street Name
Apartment/Complex Name
City
City
If you selected Other, type your city here (Your request will be evaulated as it may be outside our service area.)
State
ZIP Code
Which holiday(s) do you need help with?
Children and Wishes
NOTE: Items that are expensive are not acceptable wishes. These include iPhones, Laptops, PS5, and Xbox. If entered, those will be ignored.
Child Registration
Should be Empty: