Adopt-A-Family

Holiday support for Picture Rocks families

The District is happy to once again extend our support to the community by sponsoring our holiday Adopt-A-Family event. If you, or a family you know, would like to be adopted for the holidays, please complete the application below.

All applicants must live within the Picture Rocks Fire and Medical District.

Application deadline:

Adopt-A-Family

Parent Or Guardian Information(Required)

First Last

Email(Required)

Phone(Required)

Address(Required)

Street Address City State ZIP Code

Have you received assistance through the PRFMD Adopt-A-Family program within the last two years?(Required)

Yes

Child Information

Please select the number of children(Required)

Please enter a number from 1 to 10.

Child 1

Child 1 name(Required)

Child 1 age(Required)

Child 1 shirt size(Required)

Child 1 pant size(Required)

Child 1 shoe size(Required)

Child 1 interests(Required)

Child 2

Child 2 name(Required)

Child 2 age(Required)

Child 2 shirt size(Required)

Child 2 pant size(Required)

Child 2 shoe size(Required)

Child 2 interests(Required)

Child 3

Child 3 name(Required)

Child 3 age(Required)

Child 3 shirt size(Required)

Child 3 pant size(Required)

Child 3 shoe size(Required)

Child 3 interests(Required)

Child 4

Child 4 name(Required)

Child 4 age(Required)

Child 4 shirt size(Required)

Child 4 pant size(Required)

Child 4 shoe size(Required)

Child 4 interests(Required)

Child 5

Child 5 name(Required)

Child 5 age(Required)

Child 5 shirt size(Required)

Child 5 pant size(Required)

Child 5 shoe size(Required)

Child 5 interests(Required)

Child 6

Child 6 name(Required)

Child 6 age(Required)

Child 6 shirt size(Required)

Child 6 pant size(Required)

Child 6 shoe size(Required)

Child 6 interests(Required)

Child 7

Child 7 name(Required)

Child 7 age(Required)

Child 7 shirt size(Required)

Child 7 pant size(Required)

Child 7 shoe size(Required)

Child 7 interests(Required)

Child 8

Child 8 name(Required)

Child 8 age(Required)

Child 8 shirt size(Required)

Child 8 pant size(Required)

Child 8 shoe size(Required)

Child 8 interests(Required)

Child 9

Child 9 name(Required)

Child 9 age(Required)

Child 9 shirt size(Required)

Child 9 pant size(Required)

Child 9 shoe size(Required)

Child 9 interests(Required)

Child 10

Child 10 name(Required)

Child 10 age(Required)

Child 10 shirt size(Required)

Child 10 pant size(Required)

Child 10 shoe size(Required)

Child 10 interests(Required)

Specific Needs

Does your family have any specific needs?

Additional comments