Christmas Assistance Request
Parent or Guardian's Name
*
First Name
Last Name
Phone Number
*
Please enter a valid phone number.
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Reason for Assistance
*
Do you attend Crossroads Community Church?
*
Yes
No
You must upload the following pictures or documents:
Driver's License or Government ID of the parent of guardian
Birth certificate for each child
Uploads
*
Browse Files
Drag and drop files here
Choose a file
Cancel
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How many children are you requesting assistance for?
*
Please Select
1
2
3
4
Child 1 Information
Child's Name
*
First Name
Last Name
Child's Birthdate
*
-
Month
-
Day
Year
Date
Clothes Size
*
Shoe Size
*
Favorite Toys
Favorite Color
Special Requests
Child 2 Information
Child's Name
*
First Name
Last Name
Child's Birthdate
*
-
Month
-
Day
Year
Date
Clothes Size
*
Shoe Size
*
Favorite Toys
Favorite Color
Special Requests
Child 3 Information
Child's Name
*
First Name
Last Name
Child's Birthdate
*
-
Month
-
Day
Year
Date
Clothes Size
*
Shoe Size
*
Favorite Toys
Favorite Color
Special Requests
Child 4 Information
Child's Name
*
First Name
Last Name
Child's Birthdate
*
-
Month
-
Day
Year
Date
Clothes Size
*
Shoe Size
*
Favorite Toys
Favorite Color
Special Requests
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