AAF • Family Service

AAF Internal Staff Only

Adopt-A-Family Registration Form

Family Service Program/Department(Required)

Head Start/Early Head Start

Is this a wait listed family?(Required)

Will you be picking up on behalf of this family?(Required)

Referring Staff Name (First and Last)(Required)

Referring Staff Phone Number(Required)

Referring Staff Email(Required)

Manager Name (First and Last)(Required)

Manager Phone Number(Required)

Family Address(Required)

Street Address

Address Line 2

City

State / Province / Region

ZIP / Postal Code

Country

Used for identification of family when picking up gifts. Not required if family does not have an address or staff will be delivering/ dispersing gift directly to the designated family.

Telephone #1(Required)

Spanish Speaking Only?(Required)

Family Information

Family Last Name Only(Required)

i.e. “The Smith Family” or “The Rodriguez Family”, etc.

Number of Household Members(Required)

Please enter a number greater than or equal to 1.

If more than 10 family members please submit a new application. Add part 2 to the last name. i.e. “The Smith Family part 2”

Family Information (Check all that apply)(Required)

Single Parent Household

Military/Veteran Family

Senior Citizen

Physical or Cognitive Disabilities

Pets

Young Children

Teens

N/A

Select box above
This information is helpful in the matching processes.

Definitions are as follows:

Disabled: Includes both physical and cognitive disabilities.
Young Children: 12 or younger

Additional Information

Indicate any special needs, physical or mental disabilities, religious accommodations, reasons for services, type and # of pets etc. Please also include information regarding the family’s current situation or other ways they might need assistance. Example:The family is experiencing financial difficulties because someone in the family is out of work or disabled.

Head of House Hold (Family Member #1)

Household Members Type(Required)

Name(Required)

First Name

Gender(Required)

Age(Required)

Shoe Size(Required)

US Standard Size + Type (7.5 Men, 10 Women, 5 Toddler)

Pants(Required)

Size + Type (30×30 Adult, Large Junior)
Please add ‘ before the size

Shirt Size(Required)

Size + Type ( XS Adult, M Youth, 2 Toddler)

Head of Household Gift Suggestions(Required)

Listing items like iPods, plasma T.V.s, Xboxes, etc. or only gift cards will be removed from the application. (Helpful Examples: What kind of toys does the child play with? What is their favorite color? Do they like baby dolls or Barbie dolls? Does the child like cars or Mutant Ninja Turtles? What color makeup does mom or teenage daughter like? Does dad or teenage son like the Spurs or Cowboys?).

Family Member #2

Household Members Type(Required)

Name(Required)

First Name

Gender(Required)

Age(Required)

Shoe Size(Required)

US Standard Size + Type (7.5 Men, 10 Women, 5 Toddler)

Pants(Required)

Size + Type (30×30 Adult, Large Junior)
Please add ‘ before the size

Shirt Size(Required)

Size + Type ( XS Adult, M Youth, 2 Toddler)

#2 Specific Gift Suggestions(Required)

Family Member #3

Household Members Type(Required)

Name(Required)

First Name

Gender(Required)

Age(Required)

Shoe Size(Required)

US Standard Size + Type (7.5 Men, 10 Women, 5 Toddler)

Pants(Required)

Size + Type (30×30 Adult, Large Junior)
Please add ‘ before the size

Shirt Size(Required)

Size + Type ( XS Adult, M Youth, 2 Toddler)

#3 Specific Gift Suggestions(Required)

Family Member #4

Household Members Type(Required)

Name(Required)

First Name

Gender(Required)

Age(Required)

Shoe Size(Required)

US Standard Size + Type (7.5 Men, 10 Women, 5 Toddler)

Pants(Required)

Size + Type (30×30 Adult, Large Junior)
Please add ‘ before the size

Shirt Size(Required)

Size + Type ( XS Adult, M Youth, 2 Toddler)

#4 Specific Gift Suggestions(Required)

Family Member #5

Household Members Type(Required)

Name(Required)

First Name

Gender(Required)

Age(Required)

Shoe Size(Required)

US Standard Size + Type (7.5 Men, 10 Women, 5 Toddler)

Pants(Required)

Size + Type (30×30 Adult, Large Junior)
Please add ‘ before the size

Shirt Size(Required)

Size + Type ( XS Adult, M Youth, 2 Toddler)

#5 Specific Gift Suggestions(Required)

Family Member #6

Household Members Type(Required)

Name(Required)

First Name

Gender(Required)

Age(Required)

Shoe Size(Required)

US Standard Size + Type (7.5 Men, 10 Women, 5 Toddler)

Pants(Required)

Size + Type (30×30 Adult, Large Junior)
Please add ‘ before the size

Shirt Size(Required)

Size + Type ( XS Adult, M Youth, 2 Toddler)

#6 Specific Gift Suggestions(Required)

Family Member #7

Household Members Type(Required)

Name(Required)

First Name

Gender(Required)

Age(Required)

Shoe Size(Required)

US Standard Size + Type (7.5 Men, 10 Women, 5 Toddler)

Pants(Required)

Size + Type (30×30 Adult, Large Junior)
Please add ‘ before the size

Shirt Size(Required)

Size + Type ( XS Adult, M Youth, 2 Toddler)

#7 Specific Gift Suggestions(Required)

Family Member #8

Household Members Type(Required)

Name(Required)

First Name

Gender(Required)

Age(Required)

Shoe Size(Required)

US Standard Size + Type (7.5 Men, 10 Women, 5 Toddler)

Pants(Required)

Size + Type (30×30 Adult, Large Junior)
Please add ‘ before the size

Shirt Size(Required)

Size + Type ( XS Adult, M Youth, 2 Toddler)

#8 Specific Gift Suggestions(Required)

Family Member #9

Household Members Type(Required)

Name(Required)

First Name

Gender(Required)

Age(Required)

Shoe Size(Required)

US Standard Size + Type (7.5 Men, 10 Women, 5 Toddler)

Pants(Required)

Size + Type (30×30 Adult, Large Junior)
Please add ‘ before the size

Shirt Size(Required)

Size + Type ( XS Adult, M Youth, 2 Toddler)

#9 Specific Gift Suggestions(Required)

Family Member #10

Household Members Type(Required)

Name(Required)

First Name

Gender(Required)

Age(Required)

Shoe Size(Required)

US Standard Size + Type (7.5 Men, 10 Women, 5 Toddler)

Pants(Required)

Size + Type (30×30 Adult, Large Junior)
Please add ‘ before the size

Shirt Size(Required)

Size + Type ( XS Adult, M Youth, 2 Toddler)

#10 Specific Gift Suggestions(Required)

Pet Information(Required)

Name, type of pet, pet wish list

Referring Staff Signature(Required)

Name
First Last
Email Address*
Comments
This field is for validation purposes and should be left unchanged.

AAF Internal Staff Only

Adopt-A-Family Registration Form

Family Information

Head of House Hold (Family Member #1)

Family Member #2

Family Member #3

Family Member #4

Family Member #5

Family Member #6

Family Member #7

Family Member #8

Family Member #9

Family Member #10

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