The Lord’s Pantry at Anna’s House
303 N. Elder Ave.
Indianapolis, IN 46222
Christmas Adopt-A Family Application
Date: __________________ Have you adopted a family with us in the past? Yes No
Name of Sponsor (Family) Group or Organization: ______________________________________________________
Name of Contact Person: _________________________________________________________________________________
Street City State Zip
Phone Number: _________________________________________ Work Home Cell Pager Other (circle one)
Alternate Phone: ________________________________________ Work Home Cell Pager Other (circle one)
Email address: ___________________________________________________________________________________________
Family Request (our families range in size from 4 to 10 people)
Number of families: ____________ Size of family: ________________
Children ages 14-18 okay? ______________________
Other family characteristics desired: ___________________________________________________________________
If possible, would you like to adopt the same family you had last year? Yes No
Program deadline: All gifts must be delivered directly to the family by Saturday, Dec 17th.
Recommendations for adopting a family:
1. Food: Please provide a gift card to a local grocery store for the family to purchase items for
a Christmas dinner. Gift cards are recommended so that families may pick items that fit
their traditions and taste. We recommend a minimum of a $50 gift card for a family of four.
2. Adult Gifts: Please provide at least one new gift for each adult in the household.
3. Children: Please provide at least one new toy or game for each child 18 years and younger.
4. Clothing: Please provide an outfit of clothing and shoes for each child in the sizes provided
(if requested by the family).
You’re welcome to provide any additional items for the family such as household cleaning items or
toiletries. All the gifts should be wrapped and tagged with the recipient’s name (except for food,
cleaning supplies or toiletries).
This form can be emailed to firstname.lastname@example.org or mailed to The Lord’s Pantry,
P.O. Box 17104, Indianapolis, IN 46217 no later than December 7th. You or your organization
will be matched with a family within a week of receiving your application. The information on
your adopted family will be emailed to you.