Clone of Christmas Theme Contact Form

Please Fill out The Form God Bless

After Sunday evening 12/15/25, if you would like to register for your Christmas Food Basket, please plan to come to St James Catholic Church, this Friday 12/19/25 at 11am for late registration.

Best E-mail to reach you

example@example.codbaym

Best Phone Number

Can this phone number receive a text?

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Please Select Your Town

Please list adults at home, over 18 ( Your name first )

First NameLast Name

if any fields don't apply, just skip them

Adults at home, over 18 (Second Adult)

First NameLast Name

Adults at home, over 18 (Third Adult)

First NameLast Name

Adults at home, over 18 (Fourth Adult)

First NameLast Name

Adults at home, over 18 (Fifth Adult)

First NameLast Name

Adults at home, over 18 (Sixth Adult)

First NameLast Name

Adults at home, over 18 (Seventh Adult)

First NameLast Name

Adults at home, over 18 (Eighth Adult)

First NameLast Name

Adults at home, over 18 (Ninth Adult)

First NameLast Name

Adults at home, over 18 (Tenth Adult)

First NameLast Name

Best Home Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Mailing Address (if different)

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Kids at home, under 18

First Child's Name

First NameLast Name

First Child's Age

First Child, Boy or Girl

BoyGirl

Second Child's Name

First NameLast Name

Second Child's Age

Second Child, Boy or Girl

BoyGirl

Third Child's Name

First NameLast Name

Third Child's Age

Third Child, Boy or Girl

BoyGirl

Fourth Child's Name

First NameLast Name

Fourth Child's Age

Fourth Child, Boy or Girl

BoyGirl

Fifth Child's Name

First NameLast Name

Fifth Child's Age

Fifth Child, Boy or Girl

BoyGirl

Sixth Child's Name

First NameLast Name

Sixth Child's Age

Sixth Child, Boy or Girl

BoyGirl

Seventh Child's Name

First NameLast Name

Seventh Child's Age

Seventh Child, Boy or Girl

BoyGirl

Eighth Child's Name

First NameLast Name

Eighth Child's Age

Eighth Child, Boy or Girl

BoyGirl

Ninth Child's Name

First NameLast Name

Ninth Child's Age

Ninth Child, Boy or Girl

BoyGirl

Tenth Child's Name

First NameLast Name

Tenth Child's Age

Tenth Child, Boy or Girl

BoyGirl

Eleventh Child's Name

First NameLast Name

Eleventh Child's Age

Eleventh Child, Boy or Girl

BoyGirl

Twelfth Child's Name

First NameLast Name

Twelfth Child's Age

Twelfth Child, Boy or Girl

BoyGirl

Thirteenth Child's Name

First NameLast Name

Thirteenth Child's Age

Thirteenth Child, Boy or Girl

BoyGirl

Fourteenth Child's Name

First NameLast Name

Fourteenth Child's Age

Fourteenth Child, Boy or Girl

BoyGirl

Fifteenth Child's Name

First NameLast Name

Fifteenth Child's Age

Fifteenth Child, Boy or Girl

BoyGirl

More kids at home? Let us know! Name, Age, Boy/Girl

Is there something you need at home beyond Christmas food or children's toys? Please let us know your household Wish List.

And that’s it!

We're looking forward to making a bright Christmas for you, and the kids! Merry Christmas and God bless.

We will begin at St James Catholic Church on Harkness in Georgetown CA, December 19th. More detailed information, will be in our confirmation message a week or so ahead of then.

All Good? Click Send now!