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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 Name
Last Name
Delivery Address (Please Provide Apartment Number/Letter If Applicable)
*
Street Address
Street Address Line 2
City
State
Zip Code
Phone Number
*
Email
*
Please upload proof of residence for each child receiving a bed
*
Browse Files
Drag and drop files here
Choose a file
Examples: Piece of mail, school record(s), housing contract listing the child, etc.
Cancel
of
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
*
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Single Twin Bed
Single bed frame for 1 child
$
Free
Quantity
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1
2
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Bunk Bed (Twin)
Bunk bed frame for 2 children
$
Free
Quantity
0
1
2
3
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5
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7
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9
10
Comments, questions, or concerns?
SUBMIT APPLICATION
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