Christmas Assistance Application Form

2024 Concerned Citizens of Lynn Christmas Assistance Application

DEADLINE TO REQUEST HELP IS NOVEMBER 21, 2024 Fill out the form carefully for registration: Please make sure to hit the submit button at the end.( Complete el formulario cuidadosamente para registrare; Asegurese de presionar el boton enviar al final) Deadline for sign up is November 21, 2024
Head of Household/ Jefa/Jafe de hogar*

First NameLast Name
Address/ Direccion*

Street Address Line 2

CityState / Province

Postal / Zip Code
Email/ Correo electrinico*

Confirmation Emailexample@example.com
Phone Number/Numero de telefono*
Please enter a valid phone number.
Number of children in your home/ Numero de ninos en su hogar*
Type number
Name of children in the home

Nombre de las ninos en el hogar
#1 Childs Name/ nombre de nino/nina*

First NameLast Name
Date of Birth/ Fecha de nacimiento*

MonthDayYear
Date
Age/Edad*
Boy/Nino or Girl/Nina ?*
Type Boy or Girl
Clothing Size/ Tamano de la ropa (please indicate if it is children's size or adult size): Por favor indique si es tamano de nino o tamano de adulto
Type Size
Shoe Size/ Tamano del zapato (please indicate if it is children's size or adult size) Por favor indique si es talla de nino o talla de adulto
Type Size
What does your child need?/ Que necisita su ninos?
Type First Wish
What does your child like to play with?/ Que le gusta jugar a tu ninos?
Type Second Wish
Christmas wish#1/ Deseo de Navidad#1
Type Third Wish
Christmas wish#2/ Deseo de Navidad#2
Type Third Wish
#2 Childs Name/ Nombre de nino/nina

First NameLast Name
Date of Birth/ Fecha de nacimiento

MonthDayYear
Date
Age/ Edad:
Boy/Nino or Girl/Nina ?
Type Boy or Girl
Clothing Size/ Tamano de la ropa (please indicate if it is children's size or adult size): por favor indique si es talla de nino o talla de adulto
Type Clothing Size
Shoe Size/ Tamano del zapato (please indicate if it is children's size or adult size): Por favor indique si es talla de nino o talla adulto
Type Shoe Size
What does your child need?/ Que necesita ninos?
Type First Wish
What does your child like to play with?/ Con que le gusta jugar a tu ninos?
Type Second Wish
Christmas wish#1/ Deseo de Navidad
Type Second Wish
Christmas wish#2/ Deseo de Navidad
Type Second Wish
#3 Childs Name/ Nombre de Nino/Nina

First NameLast Name
Date of Birth/ Fecha de nacimiento

MonthDayYear
Date
Age/ Edad
Boy/Nino or Girl/Nina
Type Boy or Girl
Clothing Size/Tamano de la ropa (please indicate if it is children's size or adult size)Por favor indique si es talla de nino o talla adulto
Type Clothing Size
Shoe Size/ Tamano del zapato (please indicate if it is children's size or adult size)/ por favor indique si es talla de nino o talla adulto
Type Shoe Size
What does your child need?/ Que necesita ninos?
Type First Wish
What does your child like to play with ?/ Con que le gusta jugar a tu ninos?
Type Second Wish
Christmas wish#1/ Deseo de Navidad
Type Third Wish
Christmas wish#2/ Deseo de Navidad
Type Third Wish
#4 Childs Name/ Nombre de Nino/Nina

First NameLast Name
Date of Birth/ Fecha de nacimiento

MonthDayYear
Date
Age/ Edad
Boy/Nino or Girl/ Nina?
Type Boy or Girl
Clothing Size/ Tamano de la ropa (please indicate if it is children's size or adult size) Por favor indique si es talla de nino o tallo adulto
Type Clothing Size
Shoe Size/ Tamano del Zapato (please indicate if it is children's size or adult size) Por favor indique si es talla de nino o tallo adulto
Type Shoe Size
What does your child need?/ Que necesita su ninos?
Type First Wish
What does your child like to play with?/ Con que le gusta jugar a tu ninos?
Type Second Wish
Christmas wish#1/ Deseo de Navidad
Type Third Wish
Christmas wish#2/ Deseo de Navidad
Type Third Wish
#5 Childs Name/ Nombre de Nino/Nina

First NameLast Name
Date of Birth/ Fecha de nacimiento

MonthDayYear
Date
Age/Edad
Boy/ Nino or Girl/ Nina?
Type Boy or Girl
Clothing size/ Tamano de la ropa (please indicate if it is children's size or adult size): Por favor indique si es talla de nino o talla aduto
Type Clothing Size
Shoe size/ Tamano del zapato (please indicate if it is children's size or adult size): Por favor indique si es talla de nino o talla adulto
Type Shoe Size
What does your child need?/ Que necesita su ninos?
Type First Wish
What does your child like to play with?/ Con que le gusta jugar a tu ninos?
Type Second Wish
Christmas wish#1/ Deseo de Navidad
Type Third Wish
Christmas wish#2/ Desseo de Navidad
Type Third Wish
Please leave any comments here: Por favor deja cualquier comentario aqui.
Have you received help from Concerned Citizens of Lynn before?/ Ha recibido ayuda de ciudadanos preocupados de Lynn antes?*
Are you going to request assistance from anywhere else?/ Vas a solicitar asistencia desde algun otro lugar?*
By submitting this application, you confirm that, to the best of your knowledge, all the informatin provided is accurate and verifiably true. You also give Concerned Citizens of Lynn permission to verify any of this information.

Al enviar esta solicitud, usted confirma que, a su leal sabar y entender, toda la informacion proporcionada es preicisa y verificable. Tambien ortorga permiiso a Cocerned Citizens of Lynn para verificar esta informacion.
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2024 Concerned Citizens of Lynn Christmas Assistance Application

Name of children in the home