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Adopt-A-Senior Form for Senior
Use the form below to identify a senior who can be honored by having someone "adopt" them.
For every case of COVID in MD, respond with an act of love. Visit
mountaincc.org/daretolove
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* Indicates required question
SENIOR INFORMATION
Name of Senior
*
Your answer
School Senior Is Graduating From
*
Your answer
Gender of Senior
*
Male
Female
Prefer not to say
Address for Delivery
*
Your answer
Do you give us permission to share the address with the person "adopting" the senior?
*
If you mark no, we cannot guarantee your senior will receive an adoption gift.
Yes
No
PERSON SUBMITTING INFORMATION
Name of Person Submitting
*
Your answer
Email for Person Submitting
*
There will be an email sent once the senior has been "adopted."
Your answer
Phone Number for Person Submitting
*
This is used only if there is incorrect information or difficulties in the delivery process. Please have this NOT be a seniors number if possible.
Your answer
PERSONALIZED INFORMATION
To help the person "adopting" your senior, what are a few things that they are interested in?
*
Your answer
What kind of candy or food do they like?
Your answer
Any food allergies to be aware of?
*
Your answer
HAVING TROUBLE FILLING OUT THIS FORM?
Contact someone from the Mountain Students Team for assistance. You can reach them at Students@MountainCC.org.
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