Skip to main content
Breadcrumb
Home
2022 AFJ December Family Dinner with Gift Give Away for Children. Join us on December 16th from 6-8pm at the People's Forum!
You must have JavaScript enabled to use this form.
Contact 1
First Name
Last Name
Phone Number
Email
Communication Details
AFJ Mailing List
Yes
No
How did you hear about this dinner?
Family Empowerment Circle (Tuesdays)
Community Organizing Meeting (Thursdays)
YEP participant
Email
Referred by a friend (Please enter who referred you in the box below)
Other (please explain in the box below)
If you selected "Other" or were referred by someone please describe here.
Do you have any food allergies? If so, please describe.
Do you have any dietary restrictions?
Vegan
Vegetarian
Dairy Free
Gluten Free
No Pork
Other (if other please describe)
N/A
If you selected "Other" for dietary restrictions, please describe in detail here.
Emergency Contact Information
First Name
Last Name
Phone Number
Is there anything else you would like us to know?
Do you need any accommodations?
Not including yourself, how many additional guests are you bringing?
No Guests
1
2
3
4
5
If you are not bringing any guests, please select "no guests." To finish your registration, scroll down to the bottom of the form, accept the covid protocol, and press "submit." If you are bringing guests, please fill out their information in the contact boxes below.
Contact 2
First Name
Last Name
Does your guest have any food allergies? If so, please describe.
Does your guest have any dietary restrictions?
Vegan
Vegetarian
Dairy Free
Gluten Free
No Pork
Other (if other please describe)
N/A
If you selected "Other" for dietary restrictions, please describe in detail here.
Does this guest need any accommodations?
Is there anything else you would like us to know?
Is this guest a child? If so, would you like them to receive a gift at the holiday party?
Yes
No
My guest is a child, but does not want a gift
Please note that the registration deadline for our gift giveaway ends on 12/5.
How old is the child?
What is your child's gender preference for a gift?
Contact 3
First Name
Last Name
Does your guest have any food allergies? If so, please describe.
Does your guest have any dietary restrictions?
Vegan
Vegetarian
Dairy Free
Gluten Free
No Pork
Other (if other please describe)
N/A
If you selected "Other" for dietary restrictions, please describe in detail here.
Is there anything else you would like us to know?
Is this guest a child? If so, would you like them to receive a gift at the holiday party?
Yes
No
My guest is a child, but does not want a gift
Please note that the registration deadline for our gift giveaway ends on 12/5.
Does this guest need any accommodations?
How old is the child?
What is your child's gender preference for a gift?
Contact 4
First Name
Last Name
Does your guest have any food allergies? If so, please describe.
Does your guest have any dietary restrictions?
Vegan
Vegetarian
Dairy Free
Gluten Free
No Pork
Other (if other please describe)
N/A
If you selected "Other" for dietary restrictions, please describe in detail here.
Does this guest need any accommodations?
Is there anything else you would like us to know?
Is this guest a child? If so, would you like them to receive a gift at the holiday party?
Yes
No
My guest is a child, but does not want a gift
Please note that the registration deadline for our gift giveaway ends on 12/5.
How old is the child?
What is your child's gender preference for a gift?
Contact 5
First Name
Last Name
Does your guest have any food allergies? If so, please describe.
Does your guest have any dietary restrictions?
Vegan
Vegetarian
Dairy Free
Gluten Free
No Pork
Other (if other please describe)
N/A
If you selected "Other" for dietary restrictions, please describe in detail here.
Does this guest need any accommodations?
Is there anything else you would like us to know?
Is this guest a child? If so, would you like them to receive a gift at the holiday party?
Yes
No
My guests is a child, but does not want a gift
Please note that the registration deadline for our gift giveaway ends on 12/5.
How old is the child?
What is your child's gender preference for a gift?
Your registration through submission of this form saves you (and guests) a seat at this event and we look forward to seeing you (and your guests)! The day before the event you must email info@afj-ny.org or text (347) 973-0580 a clearly indicated negative COVID test result. A home test or lab generated test are acceptable as long as the results are clearly indicated. A blurry home test photo will not be accepted. A negative covid test submission prior to the event is needed for admission to the dinner.
Yes
I understand that admission to the event will NOT be granted if a negative COVID test picture is not received by AFJ.