Customer Details:
Thanksgiving Giveaway Box
Full Name
*
First Name
Last Name
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Phone Number
*
Format: (000) 000-0000.
E-mail
*
example@example.com
What is your family income?
*
How did you hear about us?
*
Please Select
Head Start
Instagram
Internet
Facebook
Tiktok
Other (Please specify...)
Is your child a current North Star Head Star student?
*
Yes
No
How many members are in your immediate family?
*
May The Douglas Care Foundation use your photograph in future publications or advertising materials?
*
Yes
No
Do you understand that you must PICK-UP your box from Stafford, Va on November 22, 2025?Location will be given if your application is approved.
*
Yes
No
Submit
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