Toy Recipient Registration Form

Name of group/organization receiving toys *

Address *

City *

State *

Zip code *

County *

Contact first name *

Contact last name *

Contact email address *

Confirm email address *

Please retype your email address

Phone number *

Are you a 501c3 *

Yes

No

How do you plan to use the toys (check all that apply) *

Use in our facility

Distribute to children and families we serve

Make available for use in the field

Services you provide for children in need (check all that apply) *

We would like toys from the following collections (check all that apply) *

November/December Holiday Collection

March/April Earth Week Collection

Maximum number of toys you will accept for Holidays (December) *

Maximum number of toys you will accept for Earth Week (April) *

Able to pick up toys? *

Yes

No

Can you take large toys? *

Yes

No

Terms and Conditions *

I have read and agree to the terms and conditions to be eligible to receive donations of Second Chance Toys.

Release *

I have read and agree to the release and indemnity agreement to be eligible to receive donations of Second Chance Toys.

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