Family Profile Form 2025

Welcome to Project R.E.A.C.H.’s Adopt-A-Family program intake process for the 2025 Christmas season.

Congratulations! You have been selected to participate in the 2025 Adopt-A-Family Program.

H.E.L.P. is committed to supporting families in need, and we are excited to assist your family this Christmas. We look forward to getting to know you better.

How the Program Works:

Note: Only nominated families are eligible for this program.

Step #1. Complete the Intake Form: Please fill out this form with as much detail as possible. Once approved, a host will be assigned to your family.

Note: In order to be eligible this form needs to be completed by the deadline date given of Thursday November 13th.

Step #2. Your Host will do their best to meet your family’s needs based on the information provided on this Intake Form.

We want to deliver the gifts you desire for your children and for yourself. Please make sure to be as SPECIFIC as possible in each area for each person (including yourself).

NOTE: There is a cap of $50.00 limit that applies to each item, and gift cards are not available as an option.

Step #3. Gift Delivery: After the shopping and the gifts are wrapped, we will deliver your Christmas presents to you and your family on either (December 20th or 21st).

We will contact to confirm in advance to verify time and address. If possible, please have the entire family at home when Santa and his elves arrive with your gifts to ensure a magical holiday experience for everyone.

GENERAL INFORMATION

Name of the person completing this form: *

First

Last

Relationship to Family *

School Name *

School District *

Main Family Member Contact's Phone Number *

Main Family Member Contact Email Adress *

Family current Address *

Address Line 1

Address Line 2

City

State

Zip Code

Do you live in a Apartment ? If YES please specify below. *

Apartment number and Exact Location in Complex if applicable

Is there a chance your address will change by Delivery date?

FAMILYS' CURRENT CIRCUMSTANCES

This section of the intake form allows you to share more about your family and current situation. H.E.L.P. offers a variety of resources, and the more we understand your circumstances, the better we can assist your family with the support we have available. We offer Quarterly summits with education and resources, back to School Events and Other opportunities throughout the year.

We appreciate you taking the time to fill out this form, We would appreciate hearing a little bit about your story. Where you are in life and what you are looking to change to progress to that next step?

If an adult in the home is currently looking for work, list their Name what type of work and what work experience they have?

Does the family have a working vehicle? *

If you answered 'no' and you have a car that isn't running, please explain what's wrong with the car and provide an estimate of the repair cost (if you have one) . If you don’t have a car, simply write 'NO CAR.'

Provide specific examples of how your family will benefit from this program. This is a requirement in order to participate in the 2025 Adopt A Family Program: *

Is anyone in your Immediate or extended family currently in the Military or a Veteran of Militaty Service.

WHAT IS THE SIZE OF THE FAMILY? *

Total number of adults (18 and older) plus the total number of children in the family?

1ST FAMILY MEMBER'S INFORMATION

Please be as specific as possible when filling out the next portion of the intake form. Be as detailed as possible in describing what each family member really needs and what they would really want for Christmas not to exceed $50.00 per gift, and please stay away from putting gift cards down as a choice.

Main Family Members First Name *

Adult #1 (18 years and older) ? *

Adult 18+
Teenager 13-17
Child 3-12
Toddler 0-2

Please give EXACT age *

Gender #1 *

Male
Female

When inputting the sizes for clothing and shoes, please also provide the appropriate department so that we get the right size for each family member.

Specific Size Guideline to reference to: M-Men's Xtra SMALL -Top Sizes 30-33 - Waist 26/29 *SMALL-Top Sizes 34-37 - Waist 30/33 *MEDIUM- Top Sizes 38-41 - Waist 34/37 *LARGE Top Sizes 42-45 Waist 38/41 *XL Top Sizes 46-48 Waist 42/45 *2XL-Sizes 50-52 Waist 46/49 *3XXL-sizes 54-56 Waist 50/53 ** WOMEN'S XS (Xtra SMALL)- Top Sizes 0-2/ Waist 24/25 *SMALL- Top Sizes 4-6/ Waist 26/27 *MEDIUM-Sizes 8-10 Waist 28/29 LARGE-sizes 12-14 Waist 30/31 XL- sizes 16-18 Waist 32/33 2XXL- sizes 20-22 Waist 34/35 3XXXL-sizes 24-26 Waist 36/37 4XXXXL- sizes 28-32 Waist 38/39 ** YOUTH/JUNIOR- Xtra SMALL sizes 0-1 SMALL- sizes 3-5 MEDIUM- sizes 7-9 LARGE- sizes 11-13 Xtra LARGE- size 15-17 ** CHILDREN Size 4C- Ages 3 to 4 Size 5C- Ages 4 to 5 Size 6C- Ages 5 to 6 Sizes 6X/7- Ages 6 to 7 * TODDLER 2T-5T * INFANTS 0-24 months

Clothing Department *

Clothing Sizes SEE above Specific SIZE Guidlines *

Please give EXACT age *

Clothing Sizes *

Shirt/Top Size SEE above Specific SIZE Guidlines *

Pants/Bottom Size: (if Toddler choose Small) SEE above Specific SIZE Guidlines *

Please give EXACT size for Mens need the Waist X Length

Different Shoe Sizes:

Men’s shoe sizes 6-16 Women’s shoe sizes: 6-12 Children shoe sizes: 11-6 Toddlers shoe sizes: 4-10 Infants (0-9mo) shoe sizes: 0-3.5

Shoe Department: *

Shoe Size: *

Please give EXACT Size

Shoe Width: *

What are you in NEED of this Christmas? *(Essentials or Specific needs, be detailed) *

What essentials do you need (clothes, jackets, shoes etc)? Not to exceed $50.00 each gift. List a couple of items including colors if applicable. Be SPECIFIC ! Please do not put down gift cards.

What would you LIKE to get for Christmas? (Wants/ Wish List) Include favorite Color, Hobbies, Sports, Characters ****For example: Gold Shoes, Drawing, Basketball, Batman *

Not to exceed $50.00 each gift. List a couple of items including colors if applicable. Be SPECIFIC ! Please do not put down gift cards.

Thank You for completing the 2025 Adopt-A Family Intake Form. You're welcome to share any additional details you'd like with your host family here.

Once approved you will be contacted by one of our Team members. At that time we can address any questions/concerns.

2ND FAMILY MEMBERS INFORMATION

Family Members First Name *

Adult #2 (18 years and older) or Child #2? *

Adult 18+
Teenager 13-17
Child 3-12
Toddler 0-2

Please give EXACT age *

Gender #2 *

Male
Female

When inputting the sizes for clothing and shoes, please also provide the appropriate department so that we get the right size for each family member.

Clothing Department #2 *

Clothing Sizes #2 - SEE above Specific SIZE Guidlines *** for Toddler choose small *** *

Please give EXACT age *

Clothing Sizes #2 - SEE above Specific SIZE Guidlines *

Shirt/Top Size #2 - SEE above Specific SIZE Guidlines *** for Toddler choose small *** *

Pants/Bottom Size: #2 SEE above Specific SIZE Guidlines *

NOTE: Please give EXACT size for Mens need the Waist X Length All others give exact size ex: Size 10 Boys Pants

Different Shoe Sizes: #2

Men’s shoe sizes 6-16 Women’s shoe sizes: 6-12 Children shoe sizes: 11-6 Toddlers shoe sizes: 4-10 Infants (0-9mo) shoe sizes: 0-3.5

Shoe Department: #2 *

Shoe Size: #2 *

Please give EXACT Size

Shoe Width: #2 *

What are you in NEED of this Christmas? *(Essentials or Specific needs, be detailed) *

What essentials do you need (clothes, jackets, shoes etc)? Not to exceed $50.00 each gift. List a couple of items including colors if applicable. Be SPECIFIC ! Please do not put down gift cards.

What would you LIKE to get for Christmas? (Wants/ Wish List) Include favorite Color, Hobbies, Sports, Characters ****For example: Gold Shoes, Drawing, Basketball, Batman *

Not to exceed $50.00 each gift. List a couple of items including colors if applicable. Be SPECIFIC ! Please do not put down gift cards.

Thank You for completing the 2025 Adopt-A Family Intake Form. You're welcome to share any additional details you'd like with your host family here.

Once approved you will be contacted by one of our Team members. At that time we can address any questions/concerns.

3rd FAMILY MEMBERS INFORMATION

Family Members First Name #3 *

Adult #3 (18 years and older) or Child #3? *

Adult 18+
Teenager 13-17
Child 3-12
Toddler 0-2

Please give EXACT age *

Gender #3 *

Male
Female

When inputting the sizes for clothing and shoes, please also provide the appropriate department so that we get the right size for each family member.

Clothing Department #3 *

Clothing Sizes #3 SEE above Specific SIZE Guidlines *** for Toddler choose small *** *

Please give EXACT age *

Clothing Sizes #3 SEE above Specific SIZE Guidlines *

Shirt/Top Size #3 SEE above Specific SIZE Guidlines *** for Toddler choose small *** *

Pants/Bottom Size: #3 SEE above Specific SIZE Guidlines *

Please give EXACT size for Mens need the Waist X Length

Different Shoe Sizes:

Men’s shoe sizes 6-16 Women’s shoe sizes: 6-12 Children shoe sizes: 11-6 Toddlers shoe sizes: 4-10 Infants (0-9mo) shoe sizes: 0-3.5

Shoe Department: #3 *

Shoe Size: #3 *

Please give EXACT Size

Shoe Width: #3 *

What are you in NEED of this Christmas? *(Essentials or Specific needs, be detailed) *

What essentials do you need (clothes, jackets, shoes etc)? Not to exceed $50.00 each gift. List a couple of items including colors if applicable. Be SPECIFIC ! Please do not put down gift cards.

What would you LIKE to get for Christmas? (Wants/ Wish List) Include favorite Color, Hobbies, Sports, Characters ****For example: Gold Shoes, Drawing, Basketball, Batman *

Not to exceed $50.00 each gift. List a couple of items including colors if applicable. Be SPECIFIC ! Please do not put down gift cards.

Thank You for completing the 2025 Adopt-A Family Intake Form. You're welcome to share any additional details you'd like with your host family here.

Once approved you will be contacted by one of our Team members. At that time we can address any questions/concerns.

4th FAMILY MEMBER'S INFORMATION

Family Members First Name #4 *

Adult #4 (18 years and older) or Child #4? *

Adult 18+
Teenager 13-17
Child 3-12
Toddler 0-2

Please give EXACT age *

Gender #4 *

Male
Female

When inputting the sizes for clothing and shoes, please also provide the appropriate department so that we get the right size for each family member.

Clothing Department #4 *

Clothing Sizes #4 SEE above Specific SIZE Guidlines *** for Toddler choose small *** *

Please give EXACT age *

Clothing Sizes #4 SEE above Specific SIZE Guidlines *

Shirt/Top Size #4 SEE above Specific SIZE Guidlines *** for Toddler choose small *** *

Pants/Bottom Size: #4 SEE above Specific SIZE Guidlines *

Please give EXACT size for Mens need the Waist X Length

Different Shoe Sizes:

Men’s shoe sizes 6-16 Women’s shoe sizes: 6-12 Children shoe sizes: 11-6 Toddlers shoe sizes: 4-10 Infants (0-9mo) shoe sizes: 0-3.5

Shoe Department: #4 *

Shoe Size: #4 *

Please give EXACT Size

Shoe Width: #4 *

What are you in NEED of this Christmas? *(Essentials or Specific needs, be detailed) *

What essentials do you need (clothes, jackets, shoes etc)? Not to exceed $50.00 each gift. List a couple of items including colors if applicable. Be SPECIFIC ! Please do not put down gift cards.

What would you LIKE to get for Christmas? (Wants/ Wish List) Include favorite Color, Hobbies, Sports, Characters ****For example: Gold Shoes, Drawing, Basketball, Batman *

Not to exceed $50.00 each gift. List a couple of items including colors if applicable. Be SPECIFIC ! Please do not put down gift cards.

Thank You for completing the 2025 Adopt-A Family Intake Form. You're welcome to share any additional details you'd like with your host family here.

Once approved you will be contacted by one of our Team members. At that time we can address any questions/concerns.

5th FAMILY MEMBER'S INFORMATION

Family Members First Name #5 *

Adult #5 (18 years and older) or Child #5? *

Adult 18+
Teenager 13-17
Child 3-12
Toddler 0-2

Please give EXACT age *

Gender #5 *

Male
Female

When inputting the sizes for clothing and shoes, please also provide the appropriate department so that we get the right size for each family member.

Clothing Department #5 *

Clothing Sizes #5 SEE above Specific SIZE Guidlines *** for Toddler choose small *** *

Please give EXACT age *

Clothing Sizes #5 SEE above Specific SIZE Guidlines *

Shirt/Top Size #5 SEE above Specific SIZE Guidlines *** for Toddler choose small *** *

Pants/Bottom Size: #5 SEE above Specific SIZE Guidlines *

Please give EXACT size for Mens need the Waist X Length

Different Shoe Sizes:

Men’s shoe sizes 6-16 Women’s shoe sizes: 6-12 Children shoe sizes: 11-6 Toddlers shoe sizes: 4-10 Infants (0-9mo) shoe sizes: 0-3.5

Shoe Department: #5 *

Shoe Size: #5 *

Please give EXACT Size

Shoe Width: #5 *

What are you in NEED of this Christmas? *(Essentials or Specific needs, be detailed) *

What essentials do you need (clothes, jackets, shoes etc)? Not to exceed $50.00 each gift. List a couple of items including colors if applicable. Be SPECIFIC ! Please do not put down gift cards.

What would you LIKE to get for Christmas? (Wants/ Wish List) Include favorite Color, Hobbies, Sports, Characters ****For example: Gold Shoes, Drawing, Basketball, Batman *

Not to exceed $50.00 each gift. List a couple of items including colors if applicable. Be SPECIFIC ! Please do not put down gift cards.

Thank You for completing the 2025 Adopt-A Family Intake Form. You're welcome to share any additional details you'd like with your host family here.

Once approved you will be contacted by one of our Team members. At that time we can address any questions/concerns.

6th FAMILY MEMBERS INFORMATION

Family Members First Name #6 *

Adult #6 (18 years and older) or Child #6? *

Adult 18+
Teenager 13-17
Child 3-12
Toddler 0-2

Please give EXACT age *

Gender #6 *

Male
Female

When inputting the sizes for clothing and shoes, please also provide the appropriate department so that we get the right size for each family member.

Clothing Department #6 *

Clothing Sizes #6 SEE above Specific SIZE Guidlines *** for Toddler choose small *** *

Please give EXACT age *

Clothing Sizes #6 SEE above Specific SIZE Guidlines *

Shirt/Top Size #6 SEE above Specific SIZE Guidlines *** for Toddler choose small *** *

Pants/Bottom Size: #6 SEE above Specific SIZE Guidlines *

Please give EXACT size for Mens need the Waist X Length

Different Shoe Sizes:

Men’s shoe sizes 6-16 Women’s shoe sizes: 6-12 Children shoe sizes: 11-6 Toddlers shoe sizes: 4-10 Infants (0-9mo) shoe sizes: 0-3.5

Shoe Department: #6 *

Shoe Size: #6 *

Please give EXACT Size

Shoe Width: #6 *

What are you in NEED of this Christmas? *(Essentials or Specific needs, be detailed) *

What essentials do you need (clothes, jackets, shoes etc)? Not to exceed $50.00 each gift. List a couple of items including colors if applicable. Be SPECIFIC ! Please do not put down gift cards.

What would you LIKE to get for Christmas? (Wants/ Wish List) Include favorite Color, Hobbies, Sports, Characters ****For example: Gold Shoes, Drawing, Basketball, Batman *

Not to exceed $50.00 each gift. List a couple of items including colors if applicable. Be SPECIFIC ! Please do not put down gift cards.

Thank You for completing the 2025 Adopt-A Family Intake Form. You're welcome to share any additional details you'd like with your host family here.

Once approved you will be contacted by one of our Team members. At that time we can address any questions/concerns.

7th FAMILY MEMBER'S INFORMATION

Family Members First Name #7 *

Adult #7 (18 years and older) or Child #7? *

Adult 18+
Teenager 13-17
Child 3-12
Toddler 0-2

Please give EXACT age *

Gender #7 *

Male
Female

When inputting the sizes for clothing and shoes, please also provide the appropriate department so that we get the right size for each family member.

Clothing Department #7 *

Clothing Sizes #7 SEE above Specific SIZE Guidlines *** for Toddler choose small *** *

Please give EXACT age *

Clothing Sizes #7 SEE above Specific SIZE Guidlines *

Shirt/Top Size #7 SEE above Specific SIZE Guidlines *** for Toddler choose small *** *

Pants/Bottom Size: #7 SEE above Specific SIZE Guidlines *

Please give EXACT size for Mens need the Waist X Length

Different Shoe Sizes:

Men’s shoe sizes 6-16 Women’s shoe sizes: 6-12 Children shoe sizes: 11-6 Toddlers shoe sizes: 4-10 Infants (0-9mo) shoe sizes: 0-3.5

Shoe Department: #7 *

Shoe Size: #7 *

Please give EXACT Size

Shoe Width: #7 *

What are you in NEED of this Christmas? *(Essentials or Specific needs, be detailed) *

What essentials do you need (clothes, jackets, shoes etc)? Not to exceed $50.00 each gift. List a couple of items including colors if applicable. Be SPECIFIC ! Please do not put down gift cards.

What would you LIKE to get for Christmas? (Wants/ Wish List) Include favorite Color, Hobbies, Sports, Characters ****For example: Gold Shoes, Drawing, Basketball, Batman *

Not to exceed $50.00 each gift. List a couple of items including colors if applicable. Be SPECIFIC ! Please do not put down gift cards.

Thank You for completing the 2025 Adopt-A Family Intake Form. You're welcome to share any additional details you'd like with your host family here.

Once approved you will be contacted by one of our Team members. At that time we can address any questions/concerns.

8th FAMILY MEMBER'S INFORMATION

Family Members First Name #8 *

Adult #8 (18 years and older) or Child #8? *

Adult 18+
Teenager 13-17
Child 3-12
Toddler 0-2

Please give EXACT age *

Gender #8 *

Male
Female

When inputting the sizes for clothing and shoes, please also provide the appropriate department so that we get the right size for each family member.

Clothing Department #8 *

Clothing Sizes #8 SEE above Specific SIZE Guidlines *** for Toddler choose small *** *

Please give EXACT age *

Clothing Sizes #8 *

Shirt/Top Size #8 SEE above Specific SIZE Guidlines *** for Toddler choose small *** *

Pants/Bottom Size: #8 SEE above Specific SIZE Guidlines *

Please give EXACT size for Mens need the Waist X Length

Different Shoe Sizes:

Men’s shoe sizes 6-16 Women’s shoe sizes: 6-12 Children shoe sizes: 11-6 Toddlers shoe sizes: 4-10 Infants (0-9mo) shoe sizes: 0-3.5

Shoe Department:#8 *

Shoe Size: #8 *

Please give EXACT Size

Shoe Width: #8 *

What are you in NEED of this Christmas? *(Essentials or Specific needs, be detailed) *

What essentials do you need (clothes, jackets, shoes etc)? Not to exceed $50.00 each gift. List a couple of items including colors if applicable. Be SPECIFIC ! Please do not put down gift cards.

What would you LIKE to get for Christmas? (Wants/ Wish List) Include favorite Color, Hobbies, Sports, Characters ****For example: Gold Shoes, Drawing, Basketball, Batman *

Not to exceed $50.00 each gift. List a couple of items including colors if applicable. Be SPECIFIC ! Please do not put down gift cards.

Thank You for completing the 2025 Adopt-A Family Intake Form. You're welcome to share any additional details you'd like with your host family here.

Once approved you will be contacted by one of our Team members. At that time we can address any questions/concerns.

9th FAMILY MEMBERS INFORMATION

Family Members First Name #9 *

Adult #9 (18 years and older) or Child #9? *

Adult 18+
Teenager 13-17
Child 3-12
Toddler 0-2

Please give EXACT age *

Gender #9 *

Male
Female

When inputting the sizes for clothing and shoes, please also provide the appropriate department so that we get the right size for each family member.

Clothing Department #9 *

Clothing Sizes #9 SEE above Specific SIZE Guidlines *** for Toddler choose small *** *

Please give EXACT age *

Clothing Sizes #9 *

Shirt/Top Size #9 SEE above Specific SIZE Guidlines *** for Toddler choose small *** *

Pants/Bottom Size: #9 SEE above Specific SIZE Guidlines *

Please give EXACT size for Mens need the Waist X Length

Different Shoe Sizes:

Men’s shoe sizes 6-16 Women’s shoe sizes: 6-12 Children shoe sizes: 11-6 Toddlers shoe sizes: 4-10 Infants (0-9mo) shoe sizes: 0-3.5

Shoe Department: #9 *

Shoe Size: #9 *

Please give EXACT Size

Shoe Width: #9 *

What are you in NEED of this Christmas? *(Essentials or Specific needs, be detailed) *

What essentials do you need (clothes, jackets, shoes etc)? Not to exceed $50.00 each gift. List a couple of items including colors if applicable. Be SPECIFIC ! Please do not put down gift cards.

What would you LIKE to get for Christmas? (Wants/ Wish List) Include favorite Color, Hobbies, Sports, Characters ****For example: Gold Shoes, Drawing, Basketball, Batman *

Not to exceed $50.00 each gift. List a couple of items including colors if applicable. Be SPECIFIC ! Please do not put down gift cards.

Thank You for completing the 2025 Adopt-A Family Intake Form. You're welcome to share any additional details you'd like with your host family here.

Once approved you will be contacted by one of our Team members. At that time we can address any questions/concerns.

10th FAMILY MEMBERS INFORMATION

Family Members First Name #10 *

Adult #10 (18 years and older) or Child #10? *

Adult 18+
Teenager 13-17
Child 3-12
Toddler 0-2

Please give EXACT age *

Gender #10 *

Male
Female

When inputting the sizes for clothing and shoes, please also provide the appropriate department so that we get the right size for each family member.

Clothing Department #10 *

Clothing Sizes #10 SEE above Specific SIZE Guidlines *** for Toddler choose small *** *

Please give EXACT age *

Clothing Sizes #10 *

Shirt/Top Size #10 SEE above Specific SIZE Guidlines *** for Toddler choose small *** *

Pants/Bottom Size: #10 SEE above Specific SIZE Guidlines *

Please give EXACT size for Mens need the Waist X Length

Different Shoe Sizes:

Men’s shoe sizes 6-16 Women’s shoe sizes: 6-12 Children shoe sizes: 11-6 Toddlers shoe sizes: 4-10 Infants (0-9mo) shoe sizes: 0-3.5

Shoe Department: #10 *

Shoe Size: #10 *

Please give EXACT Size

Shoe Width: #10 *

What are you in NEED of this Christmas? *(Essentials or Specific needs, be detailed) *

What essentials do you need (clothes, jackets, shoes etc)? Not to exceed $50.00 each gift. List a couple of items including colors if applicable. Be SPECIFIC ! Please do not put down gift cards.

What would you LIKE to get for Christmas? (Wants/ Wish List) Include favorite Color, Hobbies, Sports, Characters ****For example: Gold Shoes, Drawing, Basketball, Batman *

Not to exceed $50.00 each gift. List a couple of items including colors if applicable. Be SPECIFIC ! Please do not put down gift cards.

Thank You for completing the 2025 Adopt-A Family Intake Form. You're welcome to share any additional details you'd like with your host family here.

Once approved you will be contacted by one of our Team members. At that time we can address any questions/concerns.

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