North Lincoln Eagles Christmas Basket Application

North Lincoln Eagles Christmas Basket Application
Deadline for Applications Dec 16th 2024

Delivery on Saturday Dec 21st 2024 Someone must be home from 8:30AM to 1PM or no delivery will be made.
Name*

First NameLast Name
Phone Number*
Please enter a valid phone number.
Apartment Or Complex Name
Apt # or Space #
Cross St.
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Directions to your home
Special Needs-Handicapped. Please indicate family MemberName
Total number living in householdTotal
Do you have Cooking FacilitiesYes/No

Adult Household Members*

Children Birth to 17*

Gift Ideas for Children under 18 ($25.00 value)

I authorize release of this information to any persons or organizations for the purpose of providing us with holiday food or gifts, and I understand that the information provided on this application may be verified.
Signature*

Clear
Name of Person Filling out the Form*

First NameLast Name
Phone Number*
Please enter a valid phone number.
Fill out application completely. It must be SIGNED with PHONE NUMBER. Only one application per address. List all Persons living in household. Completing this application does not guarantee that you will receive food or gifts.
Boundaries of Areas to be Served:

North to Cascade Head East to Van Duzer Corridor South to Siletz River
Should be Empty:

Deadline for Applications Dec 16th 2024