Christmas Gift Sign Up 2022
For Staff and Volunteer Use - to sign clients up for Christmas

Please tell families  the following information.
            1. No sign ups will be taken after December 2, 2022. 
            2.  We cannot accept bike or cell phone requests as gifts
            3.  Rotary pick up date - tbd
            4.  Teen pick up date is Friday, Dec 16th from 9-12

Print this form after meeting with client.
If they signed up for Rotary/Teen cut off the bottom reminders.  Write their number on the form.
Paper clip sign up to the gift forms and put in the red Christmas gift folder.

Add name to their name and phone number to the green spiral notebook.
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Assigned Number (Look in green spiral notebook)
 *
Check pay documentation first - 
They need to show you the last 30 days of income for ALL adults in the household.

Add all income using gross amounts.  
Check the Income chart using family size and total gross income.  
If they are equal to or less than, 150% amount then they qualify for gifts and you may proceed.
If they are above, they do not qualify.  Please select no, print form so we can collect the number that tried to sign up and do no qualify.
 *
Last Name *
First Name *
Street Address *
City, State, Zip code *
Which school district do you live in? *
Phone Number *
Number of people in your household *
Do you have children aged infant-12?
Would you like to sign up for Rotary?

(No bikes or cell phones)

Complete the gift wish forms (hard copies)
 *
Do you have any teenagers?
Would you like to sign up for gifts for your teens?

(No bikes or cell phones)

Complete the gift wish forms (hard copies).
 *
Would you like to be considered for the Christmas adoption program?                                                         **Unfortunately, not everyone who signs up will be selected for the Christmas adoption program.   If your family is adopted, Human Services will contact you. Therefore, it is very important to give us a reliable phone number.        *
What is the reason you are requesting adoption? Has something happened during the last 3 months  that will prevent you from providing Christmas gifts for your children?  Please explain.   *
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