JayDay2K24 Christmas Mingle and Jingle Application

JayDay2K24 Christmas Mingle and Jingle Application

To ensure that all approved applicants are served, a government issued ID, copy of children's birth certificate and social security numbers are required. This application does not guarantee approval. You must complete application and upload these required documents to your application. Please Fill out form entirely! PLEASE UNDERSTAND IF ALL INFORMATION IS NOT SUBMITTED, YOUR APPLICATION WILL NOT BE CONSIDERED!!
Name of Applicant*

PrefixFirst NameMiddle NameLast Name
Applicants Phone Number*

Area CodePhone Number
Applicants E-mail Address*
Applicants Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Drivers License*

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Drivers License Cancelof
Do you receive public assistance? Please mark all that apply. Verification will be requested.*

MedicaidFood StampsSocial SecurityOther
Upload Award Letter

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Award Letter for Public Assistance/Social Security Cancelof
Child(ren) Info (2 -16 years old)*
Upload All Required Documents*

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Child/ren Birth Certificate/s Cancelof
Please share with us the reason you are needing assistance this year? *
Could you please inform us of the day you are available to attend a meeting with our staff? Be advised that your appointment will last approximately 20 minutes. (MANDATORY MEETING) *
Electronic Disclosure and Signature Agreement
- I know that any information given to JTB Hope Foundation Inc. will be protected and kept confidential.
- By entering your name on the signature line, you are signing this Application electronically. You agree that your electronic signature is the legal equivalent of your manual signature on this Application and is as valid as if you signed the document in writing. You also agree that no certification authority or other third party verification is necessary to validate your E-Signature, and that the lack of such certification or third party verification will not in any way affect the enforceability of your E-Signature. You further agree that your electronic signature grants JTB Hope Foundation Inc. the permission to confirm, where applicable, your income eligibility criteria, and or the residential information entered on this application.
- Please note that no phone calls will be taken! If you are an approved family under no circumstances will your toys be HELD, DROPPED OFF, OR PICKED UP AFTER the EVENT! All Children on application are required to attend this event.
- PLEASE UNDERSTAND IF ALL INFORMATION IS NOT SUBMITTED, YOUR APPLICATION WILL NOT BE CONSIDERED!!
- IF YOU APPLY FOR TOYS AND DO NOT PICK UP, YOU WILL BE BLOCKED FROM APPLYING IN THE FUTURE!
Electronic Signature*
First and Last Name
DateTime
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