Adopt-A-Family 2026 "*" indicates required fields Step 1 of 8 12% DEADLINE FOR SUBMISSIONS IS NOV. 1, 2026No additional submissions will be accepted after Nov, 1, 2026.SUBMISSION RULESREAD CAREFULLY! Please select your ONE family carefully, the one in the most need. If you have additional families you would like considered please contact management. DO NOT submit multiple families unless you pass it through management, or one of the other employees gives you their one option to submit a family. PLEASE try to be as thorough as possible, the backtracking time to correct and gather information is VERY time consuming, for both staff and yourself.Date of Referral* IMPORTANT! Select the area that best describes where the family being submitting lives in.*Gifts purchased for the area choice will indicate where the gifts will be dropped off. MACON or surrounding area. AUGUSTA or surrounding area. Submitter's InformationPerson submitting (making) this Adopt-A-Family referral. Please list all information requested.Submitter's - Name* First Last Submitter's - Email Submitter's - PhonePlease give the best phone number that you can be reached for questions concerning this referral. Family Unit InformationThis section is dedicated to determining who is the head of household (responsible party) for this referral and to determine key contacts for questions.Family Unit - Parent or Guardian Name First Last Family Unit - PhonePlease list best reach phone number here.IMPORTANT! Total Number of Children Being ReferredIMPORTANT! Please list the number of people receiving gifts this year. DO NOT include the parent or guardian.Are there additional forms being submitted for this same family?If there are more than 7 children to submit for this family you must submit an additional form. To avoid confusion do not repeat names and please label them (A) and (B) by the name. Yes No CONSENTConfirm consent to participate below.Family Unit Parent or Guardian - ConsentPlease get a verbal consent from the Family Unit Parent or Guardian. By clicking this box the person referring is attesting to the verbal agreement. I agree to participate in the Adopt-A-Family ProgramSubmitter's AttestI attest that the Family Unit - Parent or Guardian gave verbal permission to participate in the Adopt-A-Family Program. I (the Submitter) attest.Submitter's Digital SignatureWrite A NoteGift Pick-Up or Delivery AgreementFamily Unit - Gift Pick-Up or Delivery AgreementIMPORTANT! The church will not be delivering gifts. If you select delivery YOU must agree to deliver or make an agreement with another Still Waters employee to deliver. Family Representative Pick-up (see below) Still Waters Employee (who is referring this family), agrees to pick-up and deliver the gifts. IMPORTANT! The church wil no longer be delivering. Gift Pick-Up AgreementPlease remind those who pick-up bring a verification ID.Person authorized to pick-up giftsPlease list all people who authorized to pick-up the gifts. All authorized must present valid identification.Gift Pick-Up Date, Time and Location:Select the pick-up that relates to your choice of area. Please give this pick-up address to the referred family. IMPORTANT! The church will no longer be delivering gifts. If you select delivery YOU must agree to deliver or make an agreement with another Still Waters employee to deliver. AUGUSTA Area - The Resting Place Church - 4350 Wheeler Rd. Augusta, GA 30907 - Pick-up Date and Time: Dec. 12, 2026 9:30 AM - 1:30 AM Dec. MACON Area - All gifts will be delivered to the families. Delivery InformationPlease remind those who pick-up bring a verification ID.Deliver to AddressThis section MUST be filled out, if the family does not pick-up their gifts or if the gifts will be delivered we need this information. Street Address City State / Province / Region ZIP / Postal Code Special delivery notes:You can include who is delivering the gifts. When they should be delivered. Any options or requests such as don't deliver when the kids are home etc. Child 1Child 1 - Name First Last Child 1 - AgePlease indicate months or years old.Child 1 - Months or Years Months Years Child 1 - Gender Male Female Transgender (Identifies as Male) Transgender (Identifies as Female) Child 1 - RaceThis section is optional, however, it helps in selecting certain gifts such as hair products.Child 1 - Important Health InformationPlease list here any allergies or health issues that need to be considered while buying gifts. Example: No flashing light toys due to seizures, child is allergic to the stuffing in plush toys, peanut allergies etc.Child 1 - Interests and PreferencesList here ideas for gifts. Please be specific. Example: if video games wanted, indicate the game console. Be as specific as possible. Other examples: Likes Hello Kitty, wants the Hello Kitty Lip Stick Kit or Child loves basketball and wants a basketball hoop. Note: There are no guarantees the child will receive these items but it is helpful information for gift buyers.Child 1 - Favorite ColorsChild 1 - Urgent NeedsList only if child has a urgent needs. Example: Child really needs tennis shoes for school.Child 1 - Shoe Size AChild 1 - Shoe Size B Infant Toddler Youth Adult Child 1 - Shirt Size AChild 1 - Shirt Size B Infant Child Junior Adult Child 1 - Pants Size AChild 1 - Pants Size B Infant Child Junior Adult Child 1 - Coat Size AChild 1 - Coat Size B Infant Child Junior Adult Child 2Child 2 - Name First Last Child 2 - AgePlease indicate months or years old.Child 2 - Months or Years Months Years Child 2 - Gender Male Female Transgender (Identifies as Male) Transgender (Identifies as Female) Child 2 - RaceThis section is optional, however it helps in selcting gifts such as hair products.Child 2 - Important Health InformationPlease list here in allergies or health issues that would concern gift options. Example: No flashing light toys due to seizures, child is allergic to the stuffing in plush toys, peanut allergies etc.Child 2 - Interests and PreferencesList here ideas for gifts. Please be specific, example if video games wanted, indicate the game console. Be as specific as possible. Other examples: Likes Hello Kitty, wants the Hello Kitty Lip Stick Kit or Child loves basketball and wants a basketball hoop. Note: There are no guarantees the child will receive these items but it is helpful information for gift buyers.Child 2 - Favorite ColorsChild 2 - Urgent NeedsList only if child has a urgent needs. Example: Child really needs tennis shoes for school.Child 2 - Shoe Size AChild 2 - Shoe Size B Infant Toddler Youth Adult Child 2 - Shirt Size AChild 2 - Shirt Size B Infant Child Junior Adult Child 2 - Pants Size AChild 2 - Pants Size B Infant Child Junior Adult Child 2 - Coat Size AChild 2 - Coat Size B Infant Child Junior Adult Child 3Child 3 - Name First Last Child 3 - AgePlease indicate months or years old.Child 3 - Months or Years Months Years Child 3 - Gender Male Female Transgender (Identifies as Male) Transgender (Identifies as Female) Child 3 - RaceThis section is optional, however it helps in selcting gifts such as hair products.Child 3 - Important Health InformationPlease list here in allergies or health issues that would concern gift options. Example: No flashing light toys due to seizures, child is allergic to the stuffing in plush toys, peanut allergies etc.Child - Interests and PreferencesList here ideas for gifts. Please be specific, example if video games wanted, indicate the game console. Be as specific as possible. Other examples: Likes Hello Kitty, wants the Hello Kitty Lip Stick Kit or Child loves basketball and wants a basketball hoop. Note: There are no guarantees the child will receive these items but it is helpful information for gift buyers.Child 3 - Favorite ColorsChild 3 - Urgent NeedsList only if child has a urgent needs. Example: Child really needs tennis shoes for school.Child 3 - Shoe Size AChild 3 - Shoe Size B Infant Toddler Youth Adult Child 3 - Shirt Size AChild 3 - Shirt Size B Infant Child Junior Adult Child 3 - Pants Size AChild 3 - Pants Size B Infant Child Junior Adult Child 3 - Coat Size AChild 3 - Coat Size B Infant Child Junior Adult Child 4Child 4 - Name First Last Child 4 - AgePlease indicate months or years old.Child 4 - Months or Years Months Years Child 4 - Gender Male Female Transgender (Identifies as Males) Transgender (Identifies as Female) Child 4 - RaceThis section is optional, however it helps in selcting gifts such as hair products.Child 4 - Important Health InformationPlease list here in allergies or health issues that would concern gift options. Example: No flashing light toys due to seizures, child is allergic to the stuffing in plush toys, peanut allergies etc.Child 4 - Interests and PreferencesList here ideas for gifts. Please be specific, example if video games wanted, indicate the game console. Be as specific as possible. Other examples: Likes Hello Kitty, wants the Hello Kitty Lip Stick Kit or Child loves basketball and wants a basketball hoop. Note: There are no guarantees the child will receive these items but it is helpful information for gift buyers.Child 4 - Favorite ColorsChild 4 - Urgent NeedsList only if child has a urgent needs. Example: Child really needs tennis shoes for school.Child 4 - Shoe Size AChild 4 - Shoe Size B Infant Toddler Youth Adult Child 4 - Shirt Size AChild 4 - Shirt Size B Infant Child Junior Adult Child 4 - Pants Size AChild 4 - Pants Size B Infant Child Junior Adult Child 4 - Coat Size AChild 4 - Coat Size B Infant Child Junior Adult Child 5Child 5 - Name First Last Child 5 - AgePlease indicate months or years old.Child 5 - Months or Years Months Years Child 5 - Gender Male Female Transgender (Identifies as Male) Transgender (Identifies as Female) Child 5 - RaceThis section is optional, however it helps in selcting gifts such as hair products.Child 5 - Important Health InformationPlease list here in allergies or health issues that would concern gift options. Example: No flashing light toys due to seizures, child is allergic to the stuffing in plush toys, peanut allergies etc.Child 5 - Interests and PreferencesList here ideas for gifts. Please be specific, example if video games wanted, indicate the game console. Be as specific as possible. Other examples: Likes Hello Kitty, wants the Hello Kitty Lip Stick Kit or Child loves basketball and wants a basketball hoop. Note: There are no guarantees the child will receive these items but it is helpful information for gift buyers.Child 5 - Favorite ColorsChild 5 - Urgent NeedsList only if child has a urgent needs. Example: Child really needs tennis shoes for school.Child 5 - Shoe Size AChild 5 - Shoe Size B Infant Toddler Youth Adult Child 5 - Shirt Size AChild 5 - Shirt Size B Infant Child Junior Adult Child 5 - Pants Size AChild 5 - Pants Size B Infant Child Junior Adult Child 5 - Coat Size AChild 5 - Coat Size B Infant Child Junior Adult Child 6Child 6 - Name First Last Child 6 - AgePlease indicate months or years old.Child 6 - Months or Years Months Years Child 6 - RaceThis section is optional, however it helps in selcting gifts such as hair products.Child 6 - Gender Male Female Transgender (Identifies as Male) Transgender (Identifies as Female) Child 6 - Important Health InformationPlease list here in allergies or health issues that would concern gift options. Example: No flashing light toys due to seizures, child is allergic to the stuffing in plush toys, peanut allergies etc.Child 6 - Interests and PreferencesList here ideas for gifts. Please be specific, example if video games wanted, indicate the game console. Be as specific as possible. Other examples: Likes Hello Kitty, wants the Hello Kitty Lip Stick Kit or Child loves basketball and wants a basketball hoop. Note: There are no guarantees the child will receive these items but it is helpful information for gift buyers.Child 6 - Favorite ColorsChild 6 - Urgent NeedsList only if child has a urgent needs. Example: Child really needs tennis shoes for school.Child 6 - Shoe Size AChild 6 - Shoe Size B Infant Toddler Youth Adult Child 6 - Shirt Size AChild 6 - Shirt Size B Infant Child Junior Adult Child 6 - Pants Size AChild 6 - Pants Size B Infant Child Junior Adult Child 6 - Coat Size AChild 6 - Coat Size B Infant Child Junior Adult Child 7Child 7 - Name First Last Child 7 - AgePlease indicate months or years old.Child 7 - Months or Years Months Years Child 7 - Gender Male Female Transgender (Identifies as Male) Transgender (Identifies as Female) Child 7 - RaceThis section is optional, however it helps in selcting gifts such as hair products.Child 7 - Important Health InformationPlease list here in allergies or health issues that would concern gift options. Example: No flashing light toys due to seizures, child is allergic to the stuffing in plush toys, peanut allergies etc.Child 7 - Interests and PreferencesList here ideas for gifts. Please be specific, example if video games wanted, indicate the game console. Be as specific as possible. Other examples: Likes Hello Kitty, wants the Hello Kitty Lip Stick Kit or Child loves basketball and wants a basketball hoop. Note: There are no guarantees the child will receive these items but it is helpful information for gift buyers.Child 7 - Favorite ColorsChild 7 - Urgent NeedsList only if child has a urgent needs. Example: Child really needs tennis shoes for school.Child 7 - Shoe Size AChild 7 - Shoe Size B Infant Toddler Youth Adult Child 7 - Shirt Size AChild 7 - Shirt Size B Infant Child Junior Adult Child 7 - Pants Size AChild 7 - Pants Size B Infant Child Junior Adult Child 7 - Coat Size AChild 7 - Coat Size B Infant Child Junior Adult Δ
