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ANNUAL FAILSAFE-ERA CHRISTMAS SHOPPE

The Annual Failsafe-ERA Christmas Shoppe serves to support and empower families affected by incarceration who reside in Fredericksburg City, Caroline, King George, Spotsylvania, Stafford Counties with resources to provide Christmas to families with.  We provide toys and gifts for the children and food baskets.

We are also looking for Sponsors for the Following:

Toys

Gift Cards

Family Bags

Teen Bags

Christmas Dinner Items

​

For more information on sponsorships and

donations contact:

540-479-3021

Register for the Christmas Shoppe

Date of Application
Month
Day
Year
County of Residence
Fredericksburg City
Spotylvania County
Stafford County
King George County
Caroline County

Full Legal Name

Race
Black/African American
White/Caucasion
Hispanic/Latino
Asian
Native American/Alaskan
Middle Eastern/North African
Native Hawaiian/Pacific Islander
Other
Gender
Male
Female
Option 3Other
I am
Returning Citizen
Parent of an Incarcerated/ Returning Citizen
Spouse/Significant Other of an Incarcerated/Returning Citizen
Guardian of Children with Incarcerated Parent
My Loved One is
Incarcerated
Released
Household Income
Under $20,000
$20,000 - $39,999
$40,000 - $59,999
$60,000 - $79,999
$80,000 - $99,999
$100,000 - $149,999
$150,000 - $199,999
$200,000 and above
How did you hear about the Christmas Shoppe?
Current FailSafe-ERA Client
FailSafe-ERA Website
Other

Photo/Video Consent

Add your text

I hereby consent to the use of photographs/videos taken during the FailSafe-ERA Holiday Shoppe for publicity, promotional and/or educational purposes (including publications, presentations, broadcast, or other media sources. I do this will the full knowle
Yes, I do authorize FailSafe-ERA to photograph or video me during the FailSafe-ERA Holiday Shoppe
No, I do not authorize FailSafe-ERA to photograph or video me during the FailSafe-ERA Holiday Shoppe

Release and Hold Harmless Agreement

I agree to release and hold harmless FailSafe-ERA and its officers, acting officials, and agents from any and all liability, loss, damage, claims, or actions, for bodily injury and/or property damage, in accordance with current state and federal law arisi
Yes I Agree

This information collected is for Internal Use & Data purposes, FailSafe-ERA will not sell nor share your information. For more information contact 540-479-3021

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