GRACE Christmas Children's Gift Registration Form

GRACE Christmas Children's Gift Registration Form

2025
Application Date*

MonthDayYear
Date
Reason why you were not able to attend the in-person sign up day.*
Mother's/Guardian's Name

First NameLast Name
Father's/Guardian's Name

First NameLast Name
Physical Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Mailing Address (if different)

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Email
example@example.com
Mom/Guardian Phone*
Please enter a valid phone number.
Mom/Guardian Phone Type

CellHomeWork
Dad/Guardian Phone
Please enter a valid phone number.
Dad/Guardian Phone Type

CellHomeWork
Other Phone
Please enter a valid phone number.
Other Phone Type

CellHomeWork
Household size?*
Number of family members
Are you requesting Christmas gifts for these children from the Toy Lift or Salvation Army or "Shop-With-A-Cop"? If yes, you are not eligible for GRACE programs.*

YesNo

Names of Children 16 or under *Race (W= White AA= African American H=Hispanic A= Asian NA=Native American O=Other X=Not disclosed)

	Full Name	Race*	Sex	Shirt Size (Youth or Adult)	Pant Size (Youth or Adult)	Shoe Size (Youth or Adult)	School Attended
Child One
Child Two
Child Three
Child Four
Child Five
Child Six

Sources of Household Income

	Source	Amount	Verified
1
2
3
4

Wish List *Please do not request any single item valued more than $75.00.

	Age	DOB	Wish List
Child One
Child Two
Child Three
Child Four
Child Five
Child Six

TERMS AND CONSENT TO RELEASE CONFIDENTIAL INFORMATION:

I understand that this is an outreach program sponsored by Greene Alliance of Church and Community Efforts, Inc. (GRACE) and that it is supported by our local agencies, churches, schools, civic organizations, businesses and individuals in our community. I certify that the information provided is true and correct. I understand that if I have knowingly given false or misleading information in the completion of this application, I can be denied this service. I give Greene Alliance of Church and Community Efforts permission to verify my confidential information with other agencies, schools, employers, etc. I understand that none of this information will be shared or released except for the purposes of evaluating my need for holiday assistance and to confirm residency in Greene County. I understand that the Wish List items are not guaranteed and that this list is intended to serve as a guide to those who wish to contribute to families in need of this assistance. I will be responsible for picking up my gifts from the designated place and during the distribution date and times listed on my card; otherwise, the gifts will be forfeited.

I understand that I will still need to upload my proof of income and residence ID or bring this to the GRACE Office. This form is being used because I was not able to attend the in-person sign ups.
Printed Name of Applicant*

First NameLast Name
Signature*

Clear
Date of Signature*

MonthDayYear
Date
Use this form to upload ID, proof of income, child guardianship information.

Cancelof

GRACE CHRISTMAS GIFT PROGRAM DISCLAIMER

Welcome to our Christmas Gift Program. The goal of this program is to provide gifts for children whose families have no other means of providing gifts for them. There are other programs that also do this, such as Toy Lift, Salvation Army, and “Shop-With-A-Cop.” If you have already signed up or plan to sign up for either of these programs, you are ineligible to sign up for the GRACE program.

GRACE has asked you to provide us with some information that we would like to explain:

1.       Your picture ID (usually your driver’s license) helps our volunteers verify that you are who you say you are and that you live in Greene County. If your address is not correct on your driver’s license, or does not show your current physical address, please present other proof of your address (e.g., electric bill with your name and address).

2.       We have asked for proof that the child on whose behalf you are applying lives with you (birth certificate or other paper showing the child’s name and same address as yours). We need a parent or legal guardian to come in and fill out the paperwork. If you are not the parent or legal guardian, you must show proof of guardianship awarded by the courts.

3.       We have asked that you bring proof of your income. Income includes pay stubs from jobs, child support/alimony, TANF, disability award letters, Social Security award letters, etc. Your income must not exceed 200% of Continental United States poverty guidelines.

Parents are responsible for accurate contact information and keeping their phones active in case GRACE needs to contact the family for additional information. GRACE's inability to contact you may result in your gift requests not being honored.

Gifts not picked up by closing time on distribution day will be forfeited and given to another family in Greene County needing this assistance. If you designate someone else to pick up your gifts, that person MUST bring your family card AND a letter signed by you authorizing them to pick up your gifts; otherwise, the gifts will not be released to them. The person picking up your gifts will be asked to show their ID. If someone else picks up your gifts on your behalf, GRACE does not guarantee that the gifts you receive are the same as those given to your authorized pick-up person.

In the WISH LIST section of the registration form, please provide a clear explanation of your child’s wishes. If requesting clothing or shoes, please list shirt, pant and shoe sizes and specify the sizes as “youth” or “adult” sizes. Please avoid listing expensive items over $50, such as computers, TV’s, Ipod touches, Ipads, x-boxes, Wii, etc. Our sponsors are often on limited incomes too and cannot afford to provide these items to their own children or for GRACE gift recipients. If the child wants an expensive item and they are willing to settle for a used item, please mention that on their wish list.

Please understand that the WISH LIST serves as a guide for our sponsors as they do their shopping. GRACE cannot guarantee that your child will receive everything you put down. Please allow extra pick up time on distribution day as you are likely to experience a wait.

I understand that the terms of this registration form and have received a copy of the above disclaimer terms.
CLIENT'S INITIALS:*

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