Christmas Assistance

1

Parent/Guardian's Name* This field is required.

First Name

Middle Name

Last Name

2

Parent/Date of Birth* This field is required.

Date

4

Gender* This field is required.

Male

Female

N/A

Other

6

Email

example@example.com

7

Phone Number

8

Have you applied for Christmas Assistance with any other agency, church, or organization?* This field is required.

Yes

No

9

Number of children in your household (under the age of 5)* This field is required.

10

Child's Name* This field is required.

First Name

Middle Name

Last Name

11

Child's Date of Birth* This field is required.

Date

12

Gender* This field is required.

Male

Female

N/A

Other

13

What is your Boys & Girls Club Unit ?* This field is required.

(East) Boys & Girls Club

(North) Boys & Girls Club

(Isaac Lane) Boys & Girls Club

14

School Uniform Color

15

Wish List

16

Please select the following Category * This field is required.

Girl Size range: 4–16

Misses Size range: 0–18 (even numbers)

Women Size range: 14W–32W

Juniors 0–15 (odd numbers)

Boys Size range: 4–20

Men Size range: XS–XXXL

17

Size Chart

Uniform Shirt Size

Uniform Pants Size

Sock Size

Underwear / Panties

Shoes

Coat

Hat

Scarf

18

Size Chart

Book Bag

Pajama Set

Gloves

Belt

Deodorant

Soap

Lotion