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English (US)
English (UK)
Three Wishes Christmas Application
Please note that filling this form out does not guarantee gifts. We heavily rely on donations. Homeless families come first in line. We will send you a confirmation email or text within 24 hours if your application has been accepted. We do our best to fulfill all reasonable wishes but if we can't we try and give age appropriate gifts.
Name
First Name
Last Name
Email
example@example.com
Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Phone Number
Please enter a valid phone number.
Format: (000) 000-0000.
Do you have custody of children?
Yes
No
Childrens names, ages and 3 wishes (please include clothing or shoe sizes)
Are you requesting gifts at any other locations?
No
Yes
Reason for requesting gifts?
Name and contact info for person who is referring you? Case manager, School staff, doctor's office, police department, fire department, etc.
"I agree to monthly check-ins to ensure I am staying on track of my goals that are setup with a 3, 6 or 12 month plan with Three Wishes.
Yes
No
Signature
Continue
Continue
Should be Empty: