HOPE of the Grand Valley

Adopt a Family for Christmas Application 2015

Deadline to apply: December 7, 2015

Submit this application via email to:

Or FAX-970-812-4032

PLEASE KEEP THIS COPY FOR YOUR RECORDS

Early applications are recommended (before Thanksgiving)

Please print clearly and use black ink/Please be sure to return all pages with your signature and Phone number along with a copy of your most recent pay stub. If you meet all of these requirements and are approved for this program, you will be receiving a phone call and or an email to go over your application with you.

We are Proud of what you are doing for your family!!! This is why we are focusing on YOU;working parents with children under the age of 14. If you are a working parent, you are providing food, shelter, and clothing for your children, but when it comes to Christmas, this is a stress point for you. HOPE of the Grand Valley would be honored to provide you and your children Christmas and save you that stress. We understand you will do whatever you need to do for your children, and we applaud you for this love and commitment! This is why we want to take care of Christmas for you! This way you will have the funds to pay your bills come January.

You qualify for the HOPE of the Grand Valley Christmas program if you answer yes ALL of the below questions:

  1. You have Children under the age of 14 in your home.
  2. You have at least one working adult in your family (most recent paystub required with application)
  3. You do not receive food, tanfor housingassistance
  4. You have not and will not apply for any other Christmas programs in Mesa County
  5. If you have recently lost your job or you are a student, you may qualify for this program as long as you comply with #3.

Please fill out completely. Remember we WANT you to be making money!

TODAY’S DATE

Understand if you are accepted to HOGV’s Christmas program you will not be allowed to apply for any other Christmas programs, such as Toys for Tots or Salvation Army. Please print clearly and clearly write your email address, as we will be contacting you via email or by phone.

You will then receive phone call or an email to set up a telephone interview. If we are unable to contact you, you will be disqualified.

APPLYING PARENT
FIRST NAME / LAST NAME / SECONDARY PARENT
FIRST NAME
IF APPLICABLE / BEST PHONE NUMBER
TO REACH YOU / EMAIL ADDRESS
THIS WILL BE VERY
IMPORTANT AS WE WILL
BE EMAILING YOU OFTEN
HOME ADDRESS / TOWN / ZIP CODE / NUMBER OF CHILDREN
UNDER THE AGE OF 14 / TOTAL MEMBERS IN YOUR
FAMILY

How did you hear about HOPE of the Grand Valley’s Adopt a Family for Christmas Program?

Please tell us about you and your family below so we will know you personally:

Total Household Monthly income: Child Support income: Rent/Mortgage payment:

Are you receiving (please put yes or no for each of these questions): Food Stamps? Tanf? Housing assistance?

Where do you work(please attach your most recent pay stub to this application)

Name of parent working and where(we will NOT contact your employer):

Your Initials ______We agree to pick our gifts up from HOPE of the Grand Valley at the designated day and time

(you will receive an email with this information closer to the date)

(PLEASE BRING YOUR PHOTO ID WITH YOU)

Pick up-December 19thWE WILL NOTIFY YOU VIA EMAIL THE TIME YOU SHOULD ARRIVE TO GET YOUR GIFTS

Western Colorado Community College.2508 Blickmann Ave. Grand Junction

I understand if I do not pick our gifts up during the times given our gifts will be given to another family.

Please bring your children and expect Santa! This year Santa is bringing Mrs. Clause!

He will be there to entertain your children plus he will have additional gifts for each child.

We will have hot cocoa and cookies for you and your family to enjoy as you wait to get your gifts.

It’s a CHRISTMAS PARTY FOR YOU AND YOUR CHILDREN!

CHRISTMAS WISH LIST FOR YOUR FAMILY

Please include each family member’s information below information.

Wish item per Adult family member of $20.00.

Children AGE 10 AND UNDER, please list what they are asking Santa for this Christmas, we cannot guarantee they will receive exactly what they are asking for but we do our best to make sure each child has a huge smile on Christmas Morning.

You will receive wrapped gifts along with Christmas Dinner (this will either be the groceries for you to prepare dinner, a grocery gift card, or a pre prepared dinner for you to pick up for a local grocery store.

NAME / AGE / GENDER / SHIRT SIZE / PANT SIZE / COAT SIZE / SHOE SIZE / 20.00 GIFT / SANTA GIFT / SPECIAL NEED / FAVORITE COLOR & SCENT / OTHER FAVORITES/HOBBIES

Allergies:

Special Diet:

Other Special needs:

Other information you would like to share with us

***Required--HOPE OF THE GRAND VALLEY RELEASE

I hereby assign and grant to HOPE of the Grand Valley or those for whom they are acting as indicated the right and permission to copyright and publish photographs or pictures of me and my family in which I may be included in whole or in part or composite of reproductions thereof in color or otherwise made through any media at their studios or elsewhere for art, advertising, trade or any other similar lawful purpose whatsoever.

I also give HOPE of the Grand Valley my permission to use my story either by posting my story on their website, newspaper, or other media, to help me receive what I am needing.

I hereby waive my right to inspect and or approve the finished product or the advertising copy that may be used in connection therewith.

I also hereby agree to allow the use of these photographs, as described herein, to be taken and used with no consideration of monetary or other form of payment to me.

I hereby release and discharge HOPE of the Grand Valley, it’s successors and all persons acting under it’s permission or authority or those from whom it is acting from ay liability by virtue of any blurring, distortion, alteration, optical illusion or use in composite form that my occur or be produced in the taking of said picture or in any processing tending toward the completion of the finished product.

Your Signature______Today’s Date______Phone Number______

YOUR NAME AND EMAIL ADDRESS WILL WORK AS YOUR SIGNATURE IF SENDING THIS APPLICATION VIA EMAIL:

Your Check List:

____I meet all requirements stated on page one of the application

____I have filled out all of the information on the application and our family story

____I have filled out and signed the RELEASE

____I have attached my most recent pay stub

___I have attached a picture or pictures of my family to this email or FAXed with my application

Please submit application to: Or FAX to: 970-812-4032

Applying Parent Signature:

Todays Date Phone Number Email Address