1. Name (First & Last)

2. Email Address - only for me (I promise not to share your email with anyone else).

3. Mailing Address

4. Do you have children? How many? Ages and genders (or whatever you feel comfortable sharing.)

5. What toys or other gifts might your child(ren) like for Chanukah?

6. Are there urgent needs that you need filled as a result of Sandy? (No guarantees can be made, but I know many would like to help.)

7. Would a gift card to a national chain such as Target be helpful? If so, please list the name of stores that would be most helpful.