Toy Giveaway Registration Form

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If a child is living with you that has lost a grandparent, parent, guardian, or sibling to community violence in the City of VALLEJO, please fill out the form below. The event will be held at 2pm-5pm at The Grind 402 Toulumne St., Vallejo. Kids must be present. You will receive a call after you fill out form.

First & Last Name of Lost Loved One *

What City was relative passing? *

What year was relative passing? *

First and Last Name of Child *

Age of Child *

Ethnicity *

Black

White

Hispanic

Native American

Asian American

Other:

Gender of Child *

BOY

GIRL

School They Attend *

First and Last Name of Parent *

Parent Phone Number *

Parent Email *

Any Questions or Concerns? *

Submit

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