Christmas Registration Form 2024

Christmas Registration Form

Fill the form out COMPLETELY and include identification for ALL members of your household, as well as photo's of income statements(photo's of ID & Income Statements allowed). Any information missing will result in a denied application. Please include ALL required documents.
Applicant Name*

First NameMiddle NameLast Name
Spouse Name(includes any significant other living with you)

First NameMiddle NameLast Name
Applicant Birth Date*

MonthDayYear
Spouse Birth Date

MonthDayYear
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Applicant E-mail*
example@example.com
Mobile Number*
Relationship Status*
Do you require Gift, Stocking or Food Assistance*
How many children do you have? *
All Children within household of all ages- please include 18+
How many children are you applying for Assistance*
Children aged 0 to 17
Child 1*

First NameLast Name
Date of Birth- MM/DD/YYYY*
Gender of Child*
Child's Clothing & Shoe Size*
Child's Wishlist- Please be specific. If your family is chosen to be sponsored, this information will help your Angel while shopping*
Child 2

First NameLast Name
Date of Birth-MM/DD/YYYY
Gender of Child
Child's Clothing & Shoe Size
Child's Wishlist- Please be specific. If your family is chosen to be sponsored, this information will help your Angel while shopping
Child 3

First NameLast Name
Date of Birth-MM/DD/YYYY
Gender of Child
Child's Clothing & Shoe Size
Child's Wishlist- Please be specific. If your family is chosen to be sponsored, this information will help your Angel while shopping
Child 4

First NameLast Name
Date of Birth-MM/DD/YYYY
Gender of Child
Child's Clothing & Shoe Size
Child's Wishlist- Please be specific. If your family is chosen to be sponsored, this information will help your Angel while shopping
Child 5

First NameLast Name
Date of Birth-MM/DD/YYYY
Gender of Child
Child's Clothing & Shoe Size
Child's Wishlist- Please be specific. If your family is chosen to be sponsored, this information will help your Angel while shopping
Do you require additional pages for children 6+(This is if you have more then 5 children in need of assistance)*

YesNo
Allergies in household*

YesNo
What are the allergies?*
PUT NONE IF NONE EXIST
What is your Christmas Wishlist? (Mom, Dad, Guardian)
Where do you grocery shop?
Any children in home 18+? If so, please state their full name, birthday and wishlist.
Please submit 1 photo of ALL identification for ALL members within your household*

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Please submit 1 Photo's of income statement(s) for ALL members within the household*

Cancelof
Income Statement Part 2

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By submitting this application you agree that you have NOT applied elsewhere for Christmas Assistance, and that all information above is correct? You understand that we cross reference with other organizations to ensure no "double dipping" occurs! You also understand that we DO NOT deliver, and that you will be picking up in Niagara Falls and "shopping" for your children? You agree that if found that any information provided has been proven untrue, that you will no longer qualify for assistance and be banned from using our services moving forward? *
Please type your name as a signature
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