Application for Special Wants Holiday Wish List *Lottery* Selection

*Please enter an email address that you have access to receive messages
*If you are selected for one of the lottery slots, we will send a message to this email address with instructions about how to sign up.
*You will only be able to sign up using the email address you provide, so please ensure the address is correct!

*You will be notified by September 30 if you were selected.
*You will be required to sign up your wishes between October 1-15.

You can enter your wishes at your leisure between Oct. 1-15. If you recall, in prior years it was a mad rush to type in your wishes before all the slots were filled; we are trying to improve the process and make it less stressful to ensure everyone can sign up their wishes correctly and thoroughly without rushing.
Email *
Please enter an email address above where you can receive messages. You will receive notification that you were selected by email; and you will sign up for wishes using this email address; and receive all messages related to wishes that were purchased. It is important you have access to this email box and know your password etc.
First Name *
Last Name *
Please write how your name is listed on your Facebook account. *
City *
State- 2 digit abbreviation *
Country of Residence *
How many loved ones will you be signing up? *
Information about your loved ones:
How many loved ones would you be signing up? Please provide following for each person you would be signing up:
a) their first name
b) their age (no age limit for special needs loved ones, siblings must be 17 yrs or younger)
c) special needs loved one - or sibling.

Example answer should look like this:

1) Kate, Age 4, Special needs
2) Sam, Age 15, Sibling
Enter loved one information here:
Have you participated in the Special Wants holiday wish list before?
How did you participate?
Please confirm you follow Special Wants, Inc. page; and are also a member of Special Wants: A Bacon and Juice Boxes facebook group. You must follow our page and be a member of this group to be selected for holiday wishes. *
Yes, I confirm I follow this page/am member of this group
Special Wants, Inc. facebook page
Special Wants: A Bacon and Juice Boxes project
Special Wants 501c3
President: Jo-Ann Turning
Special Wants, Inc.
PO Box 1441
Eatontown, NJ 07724
Tax ID Number: 83-4493121
Never submit passwords through Google Forms.
This content is neither created nor endorsed by Google. Report Abuse - Terms of Service - Privacy Policy