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Programs
Camp Cartwheel
Project A.R.K.
Education Services
The Caring Place
Orion Grant Fund
Fundraising
Classes/Groups
About Us
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Contact
Camp Cartwheel
Project A.R.K.
Education Services
The Caring Place
Orion Grant Fund
Menu
Camp Cartwheel
Project A.R.K.
Education Services
The Caring Place
Orion Grant Fund
702.735.8434
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ADOPTER/DONOR FORM FOR CHRISTMAS LISTS
Please view the
Holiday Adopters Packet
in it's
entirety
before filling out this form
Email
(Required)
Phone Number
(Required)
Adopter/company name
(Required)
Adopter/company address
(Required)
Street Address
Address Line 2
City
State / Province / Region
ZIP / Postal Code
Would you like to remain an anonymous donor?
(Required)
If yes, please remember to drop off all requested items from the family/families no later than MONDAY DECEMBER 13, 2021 to the NVCCF offices.
Yes
No
Please indicate the size of the family you are comfortable adopting. Remember, you are only responsible for the children in the family. If you choose to provide other items/gift cards, etc for the family in total, it is optional.
(Required)
Small (2-5)
Medium (6-7)
Large (8 or more)
How many total families are you able/willing to adopt?
(Required)
Please select 1-5.
Please enter a number from
1
to
5
.
If you would like to personally deliver to the family, please reach out to your family directly via email or phone and schedule a time.
(Required)
Will schedule with family
I would like NVCCF to schedule
Please let an NVCCF staffer know that this has been done either via phone or email.
HIPPA Consent
(Required)
NVCCF complies with the HIPPA act of 1996 in that we will ensure our client's privacy and protection during this process. Please know that adopters are also expected to keep private any information shared with them regarding the families we serve. I agree to whatever information shared will be kept confidential and there will be some information shared with the you, the adopter.
I agree
Obligation
(Required)
I/we understand the above questions and packet, and have seen the sample wish list (in packet) and know that I/we are under no obligation to fulfill the entire wish list.
I understand
Donation Form
First Name
*
Last Name
*
Email
*
Phone
Program
*
General Fund
Camp Cartwheel
Project A.R.K.
Education Services
The Caring Place
Orion Grant Fund
Select which NVCCF program you'd like to donate to.
Special designations and memos
Donation Amount
*
Minimum $5.00
Credit Card
*
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MasterCard
Visa
Supported Credit Cards: American Express, Discover, MasterCard, Visa
Card Number
Month
01
02
03
04
05
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07
08
09
10
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Year
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2031
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2034
2035
2036
2037
2038
2039
2040
2041
2042
2043
Expiration Date
Security Code
Cardholder Name
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