Christmas Assistance Application Form

WAITLIST! 2024 Christmas Toy Application (2023 Application is Closed)

Fill out the form carefully for registration
Head of Household*

First NameMiddle NameLast Name
Date of Birth*

MonthDayYear
MM-DD-YYYY
Gender*

MaleFemale
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Email:*

Confirmation Emailexample@example.com
Phone Number*
Please enter a valid phone number.
Number of people in your home:
Type number
Children in Home (12 and under)

Fill out information for each child in your home
First Child: Name*

First NameLast Name
Date of Birth*

MonthDayYear
Date
Age:*
Boy or Girl?*
Type Boy or Girl
Clothing Size (please indicate if it is children's size or adult size):
Type Size
Shoe Size (please indicate if it is children's size or adult size):
Type Size
2nd Child: Name

First NameLast Name
Date of Birth

MonthDayYear
Date
Age:
Boy or Girl?
Type Boy or Girl
Clothing Size (please indicate if it is children's size or adult size):
Type Clothing Size
Shoe Size (please indicate if it is children's size or adult size):
Type Shoe Size
3rd Child: Name

First NameLast Name
Date of Birth

MonthDayYear
Date
Age:
Boy or Girl?
Type Boy or Girl
Clothing Size (please indicate if it is children's size or adult size):
Type Clothing Size
Shoe Size (please indicate if it is children's size or adult size):
Type Shoe Size
4th Child: Name

First NameLast Name
Date of Birth

MonthDayYear
Date
Age:
Boy or Girl?
Type Boy or Girl
Clothing Size (please indicate if it is children's size or adult size):
Type Clothing Size
Shoe Size (please indicate if it is children's size or adult size):
Type Shoe Size
5th Child: Name

First NameLast Name
Date of Birth

MonthDayYear
Date
Age:
Boy or Girl?
Type Boy or Girl
Clothing Size (please indicate if it is children's size or adult size):
Type Clothing Size
Shoe Size (please indicate if it is children's size or adult size):
Type Shoe Size
6th Child: Name

First NameLast Name
Date of Birth

MonthDayYear
Date
Age:
Boy or Girl?
Type Boy or Girl
Clothing Size (please indicate if it is children's size or adult size):
Type Clothing Size
Shoe Size (please indicate if it is children's size or adult size):
Type Shoe Size
Monthly Income:

Must be filled out for everyone working in the family
Income for Head of Household*

First NameLast Name
Fill in all blanks. If not applicable, enter '0'
Amount received in Salary Monthly:
Type Amount
Amount received in Public Assistance Monthly:
Type Amount
Amount Received in Food Stamps Monthly:
Type Amount
Are you able to submit copies of assistance you receive for those in your family or proof of all income and expense? If not, you may be asked to do so before your application can be processed.*

I have already submitted copiesI'm not sure if I have. Can you email me and let me know?My income and/or expenses have changed since last year. Upload updated information belowI have not submitted copies. Upload information belowOther
Upload only (ONE) copy of a Government assistance document or updated income we do not have. (i.e. Medicaid, Food Stamps, Foster Care Documents, Check stubs

Cancelof
Do you attend church regularly? (this has no effect on your application)*
If your answer was yes, which church do you attend?Insert Church Name
Would you like information about our ministry after the Holidays? (this has no effect on your application) YesNo*
Would you like information in the spring on sending your child to our performing arts camp in the summer? YesNo*
Should be Empty:

WAITLIST! 2024 Christmas Toy Application (2023 Application is Closed)

Children in Home (12 and under)

Monthly Income: