MEGAN’S WINGS FOUNDATION CHANGING CHILDREN’S LIVES (909) 532-8135 HOLIDAY ADOPTED FAMILY FORM Please fill out & return this form to your social worker no later than MONDAY NOV 10TH to qualify for this program. Our wish is to ease financial stress around the holidays, so you can spend quality time as a family. Your family will receive a care package of gifts for the kids (from their wish list below), along with a gas, grocery & clothing card for parents & a holiday dinner compliments of Megan’s Wings. We budget $50/child for gifts. Please provide in the boxes below 3 gift ideas ($50 maximum) to help us find something your children will really love! Family Information Patient’s Name: __________________________________ Diagnosis: ________________________ December Holiday You Celebrate: ___________________ Address: __________________________________________________ City: _____________________________ Email: _____________________________________ Father: _______________________________ Phone: ________________________ Mother: ______________________________ Phone: ______________________ Hospital: ____________________________________ Social Worker: __________________________________ Soc Worker Email__________________________ Would you like your care package delivered to Home, the Hospital/Clinic or Social Services Dept? _________________________________ (To surprise your kids or use these gifts from Santa, Hanukkah or Gifts from Mom / Dad, please ask for a Social Services delivery to help keep it a secret!) For Home Deliveries, please circle 1st choice for your delivery: Dec 13 / Dec 14 Prefer: Morning / Afternoon Megan’s Wings can delivery to family homes within 30 miles from our location in Upland. Further distances will be evaluated based on our volunteer schedules, and may need to be delivered to Social Services. We will call you a few days before to confirm your delivery place, date & give a 2 hr window of time for your delivery. If your child is in the hospital, your care package will be delivered to the hospital Dec 16, 17 or 18. You will be notified the date a couple days before. Only home deliveries are guaranteed a holiday dinner due to food storage limitations at the hospital or social services. Patient & Siblings Wish List: Child’s Name Age Boy/Girl Each Child’s Holiday Wish List (toys, cloths, etc) Child’s shirt, pant & shoe size. 1. Shirt: Size 2. Pant Size: 3. 1. Shoe Size: Shirt: Size 2. Pant Size: 3. 1. Shoe Size: Shirt: Size 2. Pant Size: 3. 1. Shoe Size: Shirt: Size 2. Pant Size: 3. 1. Shoe Size: Shirt: Size 2. Pant Size: 3. 1. Shoe Size: Shirt: Size 2. Pant Size: 3. Shoe Size: If you have more than 6 children, please continue on the back. Thank you. Megan’s Wings is a non-profit volunteer based organization established in memory of 9 year old Megan Savage who lost her battle to Leukemia on April 2nd, 2003. Megan’s Wings assists families with a child undergoing cancer treatments at a Southern California Hospital or Cancer Center. It is our wish to ease the burden of childhood cancer for families and aid in the search for a cure. Megan’s Wings, Inc. Non-Profit 501(c)(3) #56-2501762