Adopt-A-Family Program: Family Profile

Over the holiday season, we connect our community clients with donors who want to make a difference. We provide our supporters with a family profile and a wish list of desired holiday gifts. On the week of December 19th, we will distribute the gifts to the community clients chosen to participate in the program.

To be selected for the Adopt-A-Family Program, this form must be completed in its entirety and submitted by September 26th for review. Any applications given after the deadline will not be considered. If you are selected as one of the families participating in the program, you will be notified the first week in October and given further instructions. Up to 20 families will be selected to participate.

Client Name(Required)

First Last

Date of Birth(Required)

Phone Number(Required)

Email(Required)

Are you pregnant?(Required)

Due Date(Required)

Are you the parent of a child under the age of one?(Required)

Age of Baby (in months)(Required)

Please enter a number from 1 to 12.

Name of Baby

Basic Information on Other Family Members

Person #1 Name

First Last

Age

Relationship

Person #2 Name

First Last

Age

Relationship

Person #3 Name

First Last

Age

Relationship

Person #4 Name

First Last

Age

Relationship

File(Required)

Upload a photo that will be linked to your Family Story. You can share photos of yourself, just your baby, your children, your whole family, etc. This should be whatever photos you feel comfortable sharing with the public. This should also be photos that best represents your family.

Max. file size: 1 GB.

Family Story(Required)

Tell us about you. Please list 3-5 pieces of information about yourself, your pregnancy, your child(ren), your family, your overall situation, etc. This can be anything you feel comfortable sharing that gives our supporters insight on the amazing person you are. Remember, you and your story are an inspiration to others.

How has CGLH made an impact on you and your family? Please provide 3-5 statements.(Required)

What are some long-term goals that you are working towards? Please list 3-5 goals.(Required)

What is one thing you would like our community supporters to know about the Life House?(Required)