Christmas for the Love of Children

Parent Name *

First Name

Last Name

Add me to OPEN M's Email List *

Yes

No

Your child's School Representative or Program Contact *

Name and contact information of school contact for all Christmas for the Love of Children related questions.

First Name

Last Name

Guardian 1 *

First Name

Last Name

Guardian 1 Birthdate

MM

DD

YYYY

Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Ethnicity *

Please provide

Hispanic or Latino

White

Black or African American

Asian

Native America or First Nations

Alaska Native

Native Hawaiian

Other Pacific Islander

Other

Guardian 2 or Alternate Contact

This person can be responsible for pickup

First Name

Last Name

Guardian 2 or Alternative Contact Birthdate

MM

DD

YYYY

Ethnicity

Please provide

Hispanic or Latino

White

Black or African American

Asian

Native America or First Nations

Alaska Native

Native Hawaiian

Other Pacific Islander

Other

Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

I grant permission to OPEN M to be photographed or videotaped for the sole purpose of promoting OPEN M *

Yes

No

Do you need pet food?

(If availability allows)

Yes

No

Child 1 *

Fill out as many child sections for the identified children ages 17 and under in the household. Submit the form at the end. Once submitted, you cannot edit the form.

First Name

Last Name

Ethnicity *

Please provide

Hispanic or Latino

White

Black or African American

Asian

Native America or First Nations

Alaska Native

Native Hawaiian

Other Pacific Islander

Other

Birthdate

MM

DD

YYYY

Child 2

Fill out as many child sections for the identified children ages 17 and under in the household. Submit the form at the end. Once submitted, you cannot edit the form.

First Name

Last Name

Ethnicity

Please provide

Hispanic or Latino

White

Black or African American

Asian

Native America or First Nations

Alaska Native

Native Hawaiian

Other Pacific Islander

Other

Birthdate

MM

DD

YYYY

Child 3

Fill out as many child sections for the identified children ages 17 and under in the household. Submit the form at the end. Once submitted, you cannot edit the form.

First Name

Last Name

Ethnicity

Please provide

Hispanic or Latino

White

Black or African American

Asian

Native America or First Nations

Alaska Native

Native Hawaiian

Other Pacific Islander

Other

Birthdate

MM

DD

YYYY

Child 4

Fill out as many child sections for the identified children ages 17 and under in the household. Submit the form at the end. Once submitted, you cannot edit the form.

First Name

Last Name

Ethnicity

Please provide

Hispanic or Latino

White

Black or African American

Asian

Native America or First Nations

Alaska Native

Native Hawaiian

Other Pacific Islander

Other

Birthdate

MM

DD

YYYY

Child 5

Fill out as many child sections for the identified children ages 17 and under in the household. Submit the form at the end. Once submitted, you cannot edit the form.

First Name

Last Name

Ethnicity

Please provide

Hispanic or Latino

White

Black or African American

Asian

Native America or First Nations

Alaska Native

Native Hawaiian

Other Pacific Islander

Other

Birthdate

MM

DD

YYYY

Child 6

Fill out as many child sections for the identified children ages 17 and under in the household. Submit the form at the end. Once submitted, you cannot edit the form.

First Name

Last Name

Ethnicity

Please provide

Hispanic or Latino

White

Black or African American

Asian

Native America or First Nations

Alaska Native

Native Hawaiian

Other Pacific Islander

Other

Birthdate

MM

DD

YYYY

Child 7

Fill out as many child sections for the identified children ages 17 and under in the household. Submit the form at the end. Once submitted, you cannot edit the form.

First Name

Last Name

Ethnicity

Please provide

Hispanic or Latino

White

Black or African American

Asian

Native America or First Nations

Alaska Native

Native Hawaiian

Other Pacific Islander

Other

Birthdate

MM

DD

YYYY

Child 8

Fill out as many child sections for the identified children ages 17 and under in the household. Submit the form at the end. Once submitted, you cannot edit the form.

First Name

Last Name

Ethnicity

Please provide

Hispanic or Latino

White

Black or African American

Asian

Native America or First Nations

Alaska Native

Native Hawaiian

Other Pacific Islander

Other

Birthdate

MM

DD

YYYY

Child 9

Fill out as many child sections for the identified children ages 17 and under in the household. Submit the form at the end. Once submitted, you cannot edit the form.

First Name

Last Name

Ethnicity

Please provide

Hispanic or Latino

White

Black or African American

Asian

Native America or First Nations

Alaska Native

Native Hawaiian

Other Pacific Islander

Other

Birthdate

MM

DD

YYYY

Child 10

Fill out as many child sections for the identified children ages 17 and under in the household. Submit the form at the end. Once submitted, you cannot edit the form.

First Name

Last Name

Ethnicity

Please provide

Hispanic or Latino

White

Black or African American

Asian

Native America or First Nations

Alaska Native

Native Hawaiian

Other Pacific Islander

Other

Birthdate

MM

DD

YYYY