Love Tree Form Logo
  • 2021 Holiday Assistance "Love Tree" Application

  • If program/activity completion is a problem, sign up with Salvation Army in Danville by their SEPTEMBER DEADLINE.

    If  you  have  questions  or  need  assistance  completing  this  packet,  please  call  your  child's  FRC/YSC  Office  or  Herald  Office  at  734-­2726  for  help.

    Qualification Eligibility & Rules (Please read carefully before signing below. Form must be signed to process.)

    By signing, I understand that I will not return any gifts that my child or children receives through this assistance program for monetary gain. If I do, I understand that I can and will be prosecuted to the full extent of the law. I also agree NOT to seek additional assistance through other community programs, churches, agencies or Go Fund Me Facebook accounts. I understand that if I do, my families' application will be denied and I will not be able to sign up on The Love Tree in the future.

    The school-age children listed for assistance are currently enrolled in and attend school in the Burgin/Mercer County School Districts OR are residents of Burgin/Mercer County, but are not old enough to attend school at this time.

    I am the custodial parent or legal guardian of the children that are listed in the application to receive assistance. Holiday assistance is per child who are less than 18 yrs. of age; not per household. I further understand that this assistance will be given to the primary custodial parent/guardian.

    I understand all applications will be crossed checked with other agencies here and in other counties for duplications. Any duplication found will void this application. Go Fund me pages or Facebook requests will also VOID your Love Tree application. 

    For families with NO school age children, I understand that I must complete at least two of the four community sponsored programs.

    For families with school age children, I understand that I must complete at least two projects at 2 hours each for a total of four (4) hours of community service. 

    I understand hours are as follows: Anderson Dean Park clean up (2) hours, Old Fort Harrod Park Clean up (2) hours, West Lane Park Clean up (2) hours, Dave Ramsey Class (2) hours.

    By signing below, I give my consent for necessary staff/agencies to share information that I have provided on this form with persons/agencies that provide assistance to families. I further understand that my signature gives my permission for my child or children's school to share information provided to them with other staff/individuals providing Holiday assistance to families.

    By signing, I understand that if I am disabled or otherwise unable to complete my requirements due to work, transportation, illness or other reasons, another family member/relative or friend MUST  complete the requirements for me. I understand that my family will not be granted assistance without completing the requirements for this program.

    By signing, I agree that I have read and understand the rules and requirements pertaining to eligibility for this holiday assistance program. I also understand that the Harrodsburg Herald charges $.10 per copy for on-site copies of any of the holiday assistance paperwork.

    ? By signing below, I verify that the information I have provided in this application is TRUE and ACCURATE. I understand that if it is discovered that the information is false, my application will be denied and I could face possible legal actions.

    The "Love Tree" Holiday Assistance Program abides by all state and federal laws pertaining to CONFIDENTIALITY and NON-DISCRIMINATION

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  • The "Love Tree" Holiday Assistance Program abides by all state and federal laws pertaining to CONFIDENTIALITY and NON-DISCRIMINATION

  • Event Verification of Attendance Page

  • Families with no school aged children and with school aged children must participate in two of the following community activities. 

  • COMMUNITY ACTIVITES 

    West Lane Park Clean Up

    When: Thursdays, Sept. 30 & Oct. 14, 6 p.m.

    Where: At the shelter house, 345 West Ln., Harrodsburg, KY 40330

     

    Old Fort Harrod Park Clean Up

    When: Thursdays, Sept. 30, Oct. 7, Oct. 14, 1 p.m.

    Where: At the ticket stand, 100 S College St, Harrodsburg, KY 40330

     

    Help Pass out Meals

    When: Weekdays thru Oct. at 11:00 a.m., Saturdays thru Oct. at 4:30 p.m.

    Where: Mercer Transformation, 132 N Main St, Harrodsburg, KY 40330

    Note: Must call ahead to let them know you are volunteering, contact Cherie Chamberlian at 859-605-2026

    Additional Opportunities Will Be Added and can be seen at https://lovetree.care/community-service-opportunities/

  • Please lsit EVERYONE who lives in the home (ALL school age children must be enrolled in the Burgin/Mercer Co. School Districts to qualify for assistance). 

  • YOU MUST SIGN IN AND SIGN OUT AT THE EVENT TO RECEIVE CREDIT! Sign in will begin 10 minutes prior to the event. 

  • Family Information

  • Directions to your home (if hard to find):

  • Please list EVERYONE who lives in the home (ALL school age children must be enrolled in the Burgin/Mercer Co. School Districts to qualify for assistance). 

  •       Age . Male/Female School Attending      Teacher      

  •       Age . Male/Female School Attending      Teacher      

  •       Age . Male/Female School Attending      Teacher      

  •       Age . Male/Female School Attending      Teacher      

  •       Age . Male/Female School Attending      Teacher      

  •       Age . Male/Female School Attending      Teacher      

  •       Age . Male/Female School Attending      Teacher      

  • If you have questions or need assistance completing this packet, please call your child's FRC/YSC Office or the Herald at 734-2726. 

  • Child Information

  • Please complete below for children living in your home (ALL school-aged children must be enrolled in Burgin/Mercer School Districts Please list as much detail as possible (likes and dislikes-see example below If necessary, attach a separate sheet to the application. The form(s) will be copied and given to your family's sponsor. READ NOTICE IN BOX BELOW

  • Do NOT include expensive electronics and gaming systems. Those items will not be purchased.

  •       Age . Male/Female Shirt Size      Pant Size   Shoe Size    

  •       Age . Male/Female Shirt Size      Pant Size   Shoe Size    

  •       Age . Male/Female Shirt Size      Pant Size   Shoe Size    

  •       Age . Male/Female Shirt Size      Pant Size   Shoe Size    

  •       Age . Male/Female Shirt Size      Pant Size   Shoe Size    

  •       Age . Male/Female Shirt Size      Pant Size   Shoe Size    

  •       Age . Male/Female Shirt Size      Pant Size   Shoe Size    

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  • By signing and submitting this I acknoledge that all the information is factual and accurate and that any attempt to defraud or abuse the program will result in no Christmas assistance this year or further years and that my attempts to defraud this program will be reported to the Salvation Army programs and any other local  programs.

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