Family 11 Registration

Family 11 Adoption Form

I am committed to helping A Mom's Helping Hand of SWFL provide Christmas help to single mother households in our community have a memorable holiday season.

Please read the Adoption Guidelines before filling out the form.

* Indicates required field

Name *

First

Last

Address *

Line 1

Line 2

City

State

Zip Code

Country

Phone Number *

Email *

I have read the Adoption Guidelines and accept these terms. *

Yes

Additional Comments *

How did you hear about this site? *

Internet Search Advertisement Friend Other

By filling out this form, I am committed to help AMHH provide assistance to a family in need and helping my adopted family have a memorable holiday season. I have read the Adoption Guidelines and understand my role as a SWFL Santa. I understand that by filling out this form I am accepting responsibility of keeping all parties informed, particularly if I am unable to follow through with my commitment.

I agree *

Yes

I acknowledge that families are located in the Lee County Florida area and if I am out of state I will need to ship the items. *

Yes

You will receive an email within 24 hours with login information with access to your personal page where your families profile will be located for quick access to view at any time.

Submit