Name: ___________________________________

Address: _________________________________

Phone: _______________   E-mail: ________________________

Child’s Name                                             Age       Gender           Sizes

1)   ___________________________     ____      _______    _________________

2)   ___________________________     ____      _______    _________________

3)   ___________________________     ____      _______    _________________

4)   ___________________________     ____      _______    _________________

If you need additional space, please use the back.

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** Please add interests of each child on back.

**Just a reminder that if you sign up at Hearts In Hands Community Center, you will 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.

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Thank you and God Bless,

Hearts in Hands Staff

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

This is not a guarantee of receipt of toys.