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HIHCC Gift of Love Program for ages 13 – 17 years old

Name: ________________________________________________

Address: ______________________________________________

Phone: _______________   E-mail: _________________________

Teen’s Name                                             Age       Gender           

1)   ___________________________     ____      _______

2)   ___________________________     ____      _______

3)   ___________________________     ____      _______ 

4)   ___________________________     ____      _______

Gift of Love Application Page 2 must be completed. Please complete either a  BOY's Application or the GIRL's Application for each teen.

**Just a reminder that if you sign up at Hearts In Hands Community Center, you may not be able to sign up with any other organizations.

**If you have a change of address or phone number, please contact Hearts In Hands as soon as possible. The information you provide on this sheet is the information we use to get in contact with you when it is time to pick up your packages.

All sign-up sheets must be returned by November 7, 2022.

This is not a guarantee of receipt of gifts.

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