Palatine Township

721 South Quentin Road, Suite 101, Palatine, IL 60067
847-358-6700 | | (847) 358-2888

Adopt A Family Wishlist

ONLY COMPLETE THIS FORM IF YOU HAVE ALREADY SUBMITTED AN APPLICATION.  IF YOU HAVE NOT YET APPLIED, CLICK HERE

The form must be completed in order to participate in the Adopt A Family program.

Please complete this “Wish List” form for your family. The program provides gift cards for parent/guardian and gifts for their children only, age 16 years and younger, who live at home.

Donors are requested to spend $50-75 on each member of your family. Please use this amount as a “guide” when completing the form. Please do not ask for expensive items such as bikes and tablets.

If the child does not need clothing do not include size information in those areas below.

Forms must be submitted no later than November 1, 2023.

You will need to fill out a separate wish list for each child.

General Assistance Case Number

Contact Information

Parent/Guardian #1






Parent/Guardian #2






Child Information