Adoption Application - Coins for Kids

Adoption Application Form

Your Information

Please provide your contact information so we can match you with a family

First Name *

Please enter your first name.

Last Name *

Please enter your last name.

Phone Number *

Please enter a valid phone number.

Alternate Phone Number

Email Address *

Please enter a valid email address.

Maximum Number of Children * How many children can you adopt? (Minimum $125 per child recommended)

Please select the number of children.

What Languages Do You Speak?

Requests/Comments

Terms and Conditions

By submitting this application, I understand and agree to the following:

Adopter Responsibilities:

I will shop for gifts using my own funds (minimum $125 per child recommended)
I will wrap all gifts before delivery
I will contact the family once matched to coordinate delivery
I will deliver gifts by December 21st
I will treat the family with respect and maintain their privacy

Program Guidelines:

Families are matched based on location and needs
Matching typically occurs in late November/early December
All personal information is kept confidential
This is a volunteer program with no monetary compensation

Privacy Policy:

Your personal information will only be used for the Coins for Kids adoption program and will not be shared with third parties except as necessary to facilitate the adoption process.

Commitment:

I understand that by adopting a family, I am making a commitment to provide Christmas gifts for children in need. I will fulfill this commitment to the best of my ability.

I have read and agree to the terms and conditions *

You must agree to the terms and conditions.

I confirm my commitment to adopt and provide gifts for a family *

Please confirm your commitment.

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