Date Rec’d __________________________

                                                                                                                     Family Code
                                                                Donor Form

     y embracing the true spirit of Lōkahi – unity, the coming
B    together for the good of all – each year thousands of families
and individuals were blessed by the generosity of others through the
                                                                                 Applicants are encouraged to let Lokahi know of other basic
                                                                                 necessities that they may need. Under Special Needs on their
                                                                                 application form, they may list linens, housewares, appliances,
Lokahi Giving Project’s Adopt-A-Family Program and Special Events                furniture, medical or baby items, or bare essentials such as
Program. Businesses, employee groups, civic and sports clubs,                    cleaning products, toiletries, and food. It would be wonderful if you
churches, schools and ohana came together to make a huge impact                  are able to provide for any of these special needs, but that is not
on our community by providing the most basic needs as well as                    required or expected to participate. These items may be provided
granting holiday wishes to help brighten the Christmas season for                through Lokahi general donations.
                                                                                 Through the Lokahi Giving Project’s Special Events Program, you
The Lokahi Adopt-A-Family Program, a unique program sponsored                    can conduct a drive or coordinate a fundraiser and choose what
by KHON2, works with over 280 non-profits and social service                     need the proceeds should address. You can adopt a group instead of
agencies, shelters, group homes, and hospitals to identify                       a family. These are usually non-related individuals that live
families and individuals needing help. When you choose to adopt                  together in a care home, group home or shelter. They can be
one or more of these families, you’ll receive the family members’                seniors, folks with mental or physical disabilities or at-risk teens
first names, ages, special needs and their Christmas wishes, a brief             and children. Or you can provide an opportunity for a Special Event
description of their challenges and how you can help.                            by creating your own event, i.e., Christmas party; or provide tickets
                                                                                 to movies, water park, ballet, concerts, or sporting events. If you
When you choose to participate, we ask our donors to provide two                 wish to participate in this program, please check the box below to
things: ■ Holiday Meal — may be in the form of food baskets,                     indicate your interest.
grocery store or restaurant certificates; ■ Christmas Gifts —provide
at least one new gift for each person listed on the form provided to             For your convenience, Donor Forms are available online at
you.                                                                             www.khon2.com or www.lokahigivingproject.com. Once we
                                                                                 have received your completed form, by fax, email or snail mail, a
It is suggested that you plan to spend approximately $35 for gifts               Lokahi staff/volunteer will contact you and provide you with all the
for each person you choose to assist plus the cost of providing a                information you will need to get started on your holiday project.
Holiday meal. However, there is no limit to what you may provide
for your adoptee!                                                                Enjoy and Happy Holidays!

                                     Please type or hand-print and e-mail, fax or mail to:
        E-mail Lokahidonors@yahoo.com • Fax 808-591-4276 • The Lokahi Giving Project, KHON2, 88 Pi‘ikoi St, Honolulu, HI 96814

                                                            DONOR INFORMATION

Previous Donor         Yes       No No. of families we wish to adopt:                     Size of family:            To Adopt a Group (see below)

            Name of company, organization or group wishing to adopt a family

            Name of individual or contact individual for company, organization or group

Mailing Address

City                                                                    State             Zip                     Island
Home Ph                                    Cell                             Work                              x          Fax

E-mail Address                                                                                        Date Submitted

                                                         OTHER OPPORTUNITIES
     Adopt-A-Group                        Conduct a Drive           Call to Discuss                               Volunteer Preference
Children     # of                Gift Cards       Toiletries     Special Event                        Lokahi Office         Mall Day
Teens        # of                Toys                 Food       Special Donation                     Distribution Ctr      Net Collections
Seniors      # of                Baby Items           Other      Fundraiser                           Myself      Family    Group     #

f73b8926-a27e-4199-a97f-85f4026a2639.doc   Mahalo for participating. We look forward to working with you!!                              Rev. 9.23.2008

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