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* 1. What is the full name of the parent in the household?

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* 2. What is your cell phone number?

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* 3. PLEASE CONFIRM YOUR cell phone number

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* 4. What is your email address?

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* 5. ELIGIBILITY & GUIDELINES

Families with children under 12 who live in Rome area are eligible for the Rome Rescue Mission Christmas gift giveaway. Valid ID for the parent AND the child is required at pick up. Children must live in your household. We want to give your family a blessed Christmas.

Gifts will be distributed at the Rome Rescue Mission, 413 E Dominick St, Rome, NY. We will CALL YOU went your gifts are ready

PLEASE NOTE- FIRST NAMES WILL BE GIVEN TO LITE 98.7 AND BE ON THE AIR FOR THEIR LISTENERS TO ADOPT A CHILD TO PROVIDE A GIFT

TYPE YES if you agree to the guidelines above.

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* 6. What is the name of Child #1 in the household?

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* 7. What is the Age & Gender of Child #1

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* 8. Please add up to 2 gifts your child #1 would like that are under $25 each. Please keep in mind we will do our best to fulfill you request but it is not guaranteed.

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* 9. What is the name of Child #2 in the household?

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* 10. What is the Age & Gender of Child #2

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* 11. Please add up to 2 gifts your child #2 would like that are under $25 each

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* 12. What is the name of Child #3 in the household?

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* 13. What is the Age & Gender of Child #3

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* 14. Please add up to 2 gifts your child #3 would like that are under $25 each

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* 15. What is the name of Child #4 in the household?

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* 16. What is the Age & Gender of Child #4

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* 17. Please add up to 2 gifts your child #4 would like that are under $25 each

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* 18. What is the name of Child #5 in the household?

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* 19. What is the Age & Gender of Child #5

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* 20. Please add up to 2  gifts your child #5 would like that are under $25 each

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