Angel Tree® and Prison Fellowship® are registered trademarks of Prison Fellowship Ministries.

2015 ANGEL TREE CHRISTMAS APPLICATION Note: Photocopy, complete, and mail to Angel Tree, 44180 Riverside Pkwy, Lansdowne, VA 20176 or fax to 1-877-281-4129. If you completed this form online, you do not need to mail or fax this copy. CHURCH NAME:

DENOMINATION/AFFILIATION:

PRIMARY LANGUAGE OF CHURCH: English Spanish Bilingual Spanish/English

ID# (OFFICE USE ONLY)

PASTOR COORDINATOR Preferred Title:

Mr. Mrs. Ms. Miss Name (required):

Name:

Church’s # of Years Participating:

Years as Coordinator:

CHURCH ADDRESS COORDINATOR ADDRESS Mailing Address (PO Box permitted) Mailing Address (PO Box permitted) Street:

Street:

City, State ZIP:

City, State ZIP:

County:

County:

Physical Address (required for UPS) Physical Address (required for UPS) Street:

Street:

City, State ZIP:

City, State ZIP:

County:

County:

CHURCH INFORMATION COORDINATOR INFORMATION Primary Phone:

Phone (primary):

Fax:

Phone (secondary):

Email:

Phone (other):

Church Website Address:

Fax:

Email:

Number of children requested:

REQUIRED (please enter the number of children)

Send all program materials to: Church Address Coordinator Address

Send children’s names to: Church Address Coordinator Address

Send Name File via: Mail Fax Email If email, what file format? Excel PDF Both

Materials Requested: Full Kit No Kit, but please send #

Pkgs Angel Tags (25/pkg) #

Pkgs Bulletin Inserts (50/pkg)

We will distribute gifts: At an Angel Tree Party Home Delivery Both Other, please specify

_______________ In the event children are unavailable in our immediate area, we would be willing to:

Purchase and mail gifts to children in areas of need

Partner with a church in an area of need by:

Purchasing and delivering gifts Purchasing gifts only Delivering gifts only

Name of delivery church previously partnered with:

Desired area (where the children live) in order of preference: Assign children within a

(# miles) – mile radius or list ZIP codes, cities, or counties. (If children are not available within the requested areas, Angel Tree may assign children within a reasonable distance.)

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PARTICIPATION AGREEMENT I agree that the child and caregiver information distributed by Prison Fellowship is confidential and proprietary in nature, and that I may use it for the sole purpose of the Angel Tree program. Name, address, and other contact information will be shared only with volunteers involved in Angel Tree. No information will be shared with any other persons or organizations for any other purpose without the written permission of Prison Fellowship. This application is not a guarantee of participation. COORDINATOR SIGNATURE (REQUIRED):

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