ADOPT-A-FAMILY RECIPIENT APPLICATION

Adopt-A-Family Recipient Application Form

Palatine Township Residents:

Palatine Township is busy preparing for its annual Adopt-A-Family Program which provides under-resourced families with Christmas gifts for their families. These gifts are donated by generous members of our community.

You must be a Palatine Township Resident and submit required documents to participate.

If you would like your family to be enrolled in this program, please fill out the application online no later than October 15, 2021.

Pick up for Adopt-A-Family will be December 11, 2021.

After submitting your application, you will be notified by email if you are missing or need to update any or all documents.

You will receive your wish list via email. Please check your email including your spam and/or junk folders.

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2021 Adopt-A-Family Recipient Form

Application for Adopt-A-Family Program

Please complete all required fields.
Date Submitted
General Assistance Case Number
If you participate in Township Programs, please provide your Case Number, found on your Food Pantry card or correspondence.
Adult #1*
First Last
Adult #2
First Last
Mailing Address*
Address City State ZIP Code
Phone*
Email*
Enter Email Confirm Email
Number of children 18 and younger*
I am aware that participating in other organizations’ Christmas Programs, i.e. Adopt-A-Family is strictly prohibited. Agencies will cross reference lists, and if I am enrolled in more than one program I will be removed from the Palatine Township Programs for one year. I hereby authorize Palatine Township to use my photo in Township materials including newsletter, website and to release my name to volunteers/churches, and other organizations. I understand that my name will not be released to soliciting organizations. By clicking this checkbox, it serves as my signature and indicates that I agree with the terms of this program.*
- I agree
Phone
This field is for validation purposes and should be left unchanged.