Holiday Assistance Participation Form

Community HousingWorks
1820 S. Escondido Blvd, Suite 101
Escondido, CA 92025

Thank you for your interest in our program. By completing this form you're agreeing to make a family's season brighter by adopting them for the holidays. After submitting this form you will be contacted by a CHW employee and we'll match you with a family in need.

Question Title

* Please provide us with your contact information.

Name: *

Company:

Address: *

Address 2:

City/Town: *

State: *

ZIP: *

Email Address: *

Phone Number:

Question Title

* Please answer both of the following questions:

How many families would you like to adopt for the holidays?
How large a family are you able to provide for?

	Number of Families	Maximum number of family members for which I can provide
Please select:	Please select: Number of Families menu	Please select: Maximum number of family members for which I can provide menu

Addtional Comments

Question Title

* Would you like to adopt a senior? If yes, how many seniors would you like to adopt? (If not just skip this question)

	Maximum number of SENIORS for which I can provide:
Please select	Please select Maximum number of SENIORS for which I can provide: menu

Question Title

* Please choose a drop-off location for your Adopt-A-Family/Senior gifts? They will need to be dropped off by Tuesday, December 18th.

	CHW City Heights Office: 4305 University Ave, Suite 550, San Diego 92105	CHW Escondido Office: 1820 S Escondido Blvd, Suite 101, Escondido 92025	I prefer to deliver the gifts DIRECTLY to the family.
Please select	Please select CHW City Heights Office: 4305 University Ave, Suite 550, San Diego 92105	Please select CHW Escondido Office: 1820 S Escondido Blvd, Suite 101, Escondido 92025	Please select I prefer to deliver the gifts DIRECTLY to the family.

We want to thank you for your participation in our Holiday Assistance Program!

Question Title

* Please provide us with your contact information.

Question Title

* Please answer both of the following questions:How many families would you like to adopt for the holidays?How large a family are you able to provide for?

Question Title

* Would you like to adopt a senior? If yes, how many seniors would you like to adopt? (If not just skip this question)

Question Title

* Please choose a drop-off location for your Adopt-A-Family/Senior gifts? They will need to be dropped off by Tuesday, December 18th.

* Please answer both of the following questions:

How many families would you like to adopt for the holidays?
How large a family are you able to provide for?