HOPE of the Grand Valley

Adopt a Family for Christmas Application 2014

Deadline to apply: December 1, 2014

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 to 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 or housing assistance

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.

Today’s Date:

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

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

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:

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

Please list below name of parent working and where:

Check below which option you would prefer for your Christmas Gifts and Dinner

______Either is fine with me just let me know what works best for HOGV

______I would like our gifts brought to our family. If you choose this option we will give your adopter your phone number and address so they will be able to contact you personally to set up a good time for them to deliver to you.

______I would like to pick our gifts up from HOPE of the Grand Valley (PLEASE BRING YOUR PHOTO ID WITH YOU)

December 20th between 6:00PM and 9:00PM at the

Western Colorado Community College. 2508 Blickmann Ave. Grand Junction in theChez LenaRestaurant

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

If you choose to pick up from HOGV, please bring your children and expect Santa! 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, 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, 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

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 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

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

Applying Parent Signature: (If you are sending this application via email, please use your email address as your signature.)

Todays Date Phone Number Email Address