* 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.