2026 Cops For Tots Registration Form

Cops for Tots Application 2026

Hickory Police Department
To ensure that all approved applicants are served, a government-issued ID and each child's medicaid card are required. You must pre-register and bring the required documents to Wish House or submit documents through this application. The Cops for Tots pick up location will be 320 3RD ST SW, Hickory Police Department Training Annex. Current contact email is preferred, or a telephone number that is operational, for notification of approval. Submitting this form does not guarantee approval or acceptance.
Parent/Guardian Name

First NameMiddle NameLast Name
Parent/Guardian E-mail Address
Parent/Guardian Phone Number

Area CodePhone Number
Parent/Guardian Current Address

Street Address

Street Address Line 2

CityState

Postal / Zip CodeCountry
Please scan or take a picture of the guardian's government issued ID and attach here:

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Parent/Guardian Name 2

First NameMiddle NameLast Name
Parent/Guardian E-mail Address 2
example@example.com
Parent/Guardian Phone Number 2

Area CodePhone Number
Children Information
Child #1

First NameLast Name
Age
Gender
Please scan or take a picture of your child's Medicaid card and attach here:

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Child #2

First NameLast Name
Age
Gender
Please scan or take a picture of your child's Medicaid card and attach here:

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Child #3

First NameLast Name
Age
Gender
Please scan or take a picture of your child's Medicaid card and attach here:

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Child #4

First NameLast Name
Age
Gender
Please scan or take a picture of your child's Medicaid card and attach here:

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Child #5

First NameLast Name
Age
Gender
Please scan or take a picture of your child's Medicaid card and attach here:

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Child #6

First NameLast Name
Age
Gender
Please scan or take a picture of your child's Medicaid card and attach here:

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Eligibility Criteria

You must qualify on all of the following eligibility criteria for your application to be considered.
Current residence, must live in one of the following to qualify for Cops for Tots.
Is your family participating in the Christmas Bureau event this year?
NOTE: In order to guarantee we are able to serve as many families as possible, this service is not available to those families that have received assistance from the Christmas Bureau, or other similar services this year.
Have any of your children been serviced by Cops for Tots for the past three consecutive years?
* Please Read Carefully

The Hickory Police Department is proud to continue our tradition of Cops for Tots. Each application is submitted as a request and therefore not guaranteed. All application decisions are granted at the sole discretion of Hickory Police Department and applicant eligibility. Please submit all required documents with your application so that your request will be processed in an efficient timeframe. Please fill out all required information so we can keep you updated on your application status. To ensure that all approved applicants are served, a government issued ID is required at time of receipt of toys/goods. Toy selections will be used as guidelines and are not guaranteed.

If you have any questions please leave it in the box below.
Additional Information:
Electronic Disclosure and Signature Agreement
- I know that any information given to Cops for Tots/Hickory Police Department will be protected and kept confidential.
- I know that the information on this application is needed to determine eligibility for Cops for Tots.
- By entering your name on the signature line, you are signing this Application electronically. You agree that your electronic signature is the legal equivalent of your manual signature on this Application and is as valid as if you signed the document in writing. You also agree that no certification authority or other third party verification is necessary to validate your E-Signature, and that the lack of such certification or third party verification will not in any way affect the enforceability of your E-Signature. You further agree that your electronic signature grants Cops for Tots the permission to confirm, where applicable, your income eligibility criteria, and or the residential information entered on this application.
Electronic Signature

First and Last Name
Should be Empty: