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Project Share Registration 2021: Gifts for Children Age 18 & Under

Complete the form below to begin the registration process to receive gifts for children ages 18 and under the Project Share Adopt-a-Family program.  After submitting the form, you will receive instructions to sign up for a confirmation phone call to complete your registration.  Important: Your registration is not complete until you complete the confirmation phone call.   If you have questions or need assistance, please call 651-437-7134. 


Project Share Registration: Gifts for Children 18 and Under
First Name
Last Name
/
/
Country
Address Line 1
Address Line 2
City
State/Province
Postal Code
Phone
Race of Requesting Adult (Optional):
Combined monthly gross income for every adult in the household
Total Number of Household Members
Number of Adults
Number of Children
Child #1
First Name
Last Name
Child #1 Age
/
/
Child #1 Relationship to Requesting Adult:
Child #1 Race (Optional):
Child #2
First Name
Last Name
Child #2 Age
/
/
Child #2 Relationship to Requesting Adult
Child #2 Race: (Optional)
Child #3
First Name
Last Name
Child #3 Age
/
/
Child #3 Relationship to Requesting Adult
Child #3 Race: (Optional)
Additional Children
Please use this space for additional children. Please provide all information requested above for children #1-3.
I agree that everything written on this application is correct, true, and accurate. I understand that when I sign this I am giving Hastings Family Service permission to verify this information if necessary. I understand that I am requesting assistance from Hastings Family Service based on an emergency need and I agree not to receive holiday assistance from any other agency or resource. I understand that Hastings Family Service will deny, suspend, modify, reduce, or terminate future services if I provide untruthful or fraudulent information, if I receive holiday assistance from another source, or if I cannot demonstrate an emergency need.
Tennessen Warning: The information you share with us is confidential. The only exceptions are child protection and personal safety issues. By law, we must report child protection concerns. Also, we would need to tell someone if there are immediate safety concerns for yourself or someone else. Otherwise, we will not give out any information about you without your written permission.
Client Rights: 1. All information you share with us will remain confidential unless we have your specific permission or if there are safety concerns for yourself and others. 2. You have the right to be informed of your options for yourself or others. 3. You have the right to know why any decision about the services you receive was made. 4. You have the right to have the services provided by Hastings Family Services be accessible to you. Hastings Family Services pledges to eliminate barriers of language, communication and physical accessibility.
Program Release & Waiver: I hereby release both the donor and Hastings Family Service from any and all liability resulting from the condition of the food, products, and services which I have received, and further agree to indemnify and hold Hastings Family Service and the original donor free and harmless from any and all liabilities, damages, losses, claims, causes of action and suits of law or inequity or any other obligation whatsoever arising out of or attributed to any losses or damages suffered as a result of my use of the donated food, products, and services. The food, products, and services which I have received from Hastings Family Service is accepted in its “as is” condition. Hastings Family Service can accommodate alternative food and products choice(s) due to cultural or religious beliefs or dietary restrictions upon request. The information I will provide to Hastings Family Service is true and accurate.
I understand that my registration is not complete until I complete the confirmation phone call. After submitting this form, I will receive an email with a link to sign up for a confirmation phone call.