Floor-to-Bed Request Form

Floor-to-Bed

Request Form
About Our Program

Our Floor-to-bed program began in 2018 with the initiative of providing children with a place to receive a safe, sound, and comfortable space to sleep. Since then, City Lights Ministry has built and delivered over 2000 beds to children of all ages. We offer Single (Twin) and Bunk Bed style frames, mattress(es), sheets, pillows, etc. at not cost to you. To qualify, you must complete this form and upload proof of residence for the child or children receiving a bed donation.
Instructions: PLEASE READ!

Please complete each section below and click submit. Once you have submitted your application you will receive a confirmation via email. (IMPORTANT: Each bed is scheduled and delivered on a first-come, first-serve basis. Our primary form of communication for scheduling and delivery will be via e-mail). If you have further questions, please call our office during operating hours Monday- Thursday 10:00 AM- 3:00 PM) at 336-831-1003.
Name of applicant*

First NameLast Name
Delivery Address*

Street Address

Street Address Line 2

CityState

Zip Code
Phone Number*
Email*
Please upload proof of residence for each child receiving a bed*

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Examples: Piece of mail, school record(s), housing contract listing the child, etc.
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How many children need a bed?*
Number of girls receiving beds?*
Number of boys receiving beds?*
Please select the amount and type of bed(s) needed*
prevnext( X )
Single Twin BedSingle bed frame for 1 child
$ Free   Quantity



Bunk BedBunk bed frame for 2 children
$ Free   Quantity
Comments, questions, or concerns?
Should be Empty:

Floor-to-Bed

About Our Program

Instructions: PLEASE READ!