New Visions Holiday Celebration & Give-Away Sign Up- Registrese para la Celebracion Navideña
Date of event: Saturday, December 18th, 2021 from 9am-6pm.


Parent(s) Information- Información Parental

*CHILDREN MUST BE PRESENT @ THE DRIVE-THRU EVENT
*MUST HAVE IOWA ID or PROOF OF RESIDENCY
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Email *
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Do you reside in Southwest Iowa?- ¿Reside en el suroeste de Iowa? *
You may be asked for proof of residency. If "no" please do not fill out this form. Thank you.
Have you signed up with any other agency's gift programs?- ¿Se ha registrado en los programas de regalos de alguna otra agencia? *
New Visions list shares with multiple area agencies, if you are signed up with another agency you will be removed from our list.. Please DO NOT sign up for multiple programs. If "Yes" please do not fill out this form. Thank you.
Are the children you are applying for in your custody?- ¿Los niños que solicita están bajo su custodia? *
You may be asked to provide proof. If "no" please do not fill out this form. Thank you.
Parent Last Name - Apellido del Padre *
Parent First Name - Nombre del Padre *
Phone Number - Numero de Telephono *
Address - Direccion de Domicillio *
City - Ciudad *
Zip Code - Codigo Postal *
Parent Race - Raza del Padre: *
Ethnicity - Etnicidad *
How Many Children are in the Household - Cuantos Ninos Estan en la Casa *
Please choose a pick up time: *
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