Circus of the Heart Sign Up Form 2023 CIRCUS PRIZE IDEach family may participate in either the in-person Circus or the virtual Circus. Both will take place on Saturday, November 4 at 1:00 pm.How would you like to participate in Circus of the Heart this year?*In-PersonVirtualName* First Last Address* Street Address Address Line 2 City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code County Email* Phone*Are you an adoptive, foster or kinship family?* Yes No Number of adults who will be participating in Circus of the Heart* How many children ages 0 - 12 will be participating?* How many children ages 13 and older will be participating?* Please describe any food allergies, sensitivities or needs that we should be aware of: Would you like to receive a Circus of the Heart poster with names of children who had finalized adoptions in the past year (July 1 2022 – June 30, 2023)?* Yes No We would like to offer you a pizza night with your family. Please select which gift card you would like to receive.* Dominos Casey's Are there any special accommodations needed?VIRTUAL: Once hitting the submit button below, you will receive a confirmation email. In this confirmation email will be an ID# that will serve as your PRIZE number for the prize drawings! Do you understand that the ID# in your confirmation email will need to be held onto in order to claim a prize if you have a winning number?* Yes Please note: This is your first step in your registration process for this year’s Circus of the Heart. In the coming weeks, you will be receiving an invitation from Zoom to join the event. To join the event on November 4, 2023, you will need to have set up a Zoom account! This will allow you to join the event on November 4. The Zoom account must be associated with the email address you register with on this page. If you have any questions, please contact us at circus@fosteradoptmn.org.I understand that I need to have or create a Zoom account (free account)* Yes I acknowledge that I may only register for either in-person or virtual Circus but not both. If I or anyone in my household submits multiple registrations, the most recent registration will be used to determine my family's Circus participation.* Yes CAPTCHA Δ
