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- Date of Birth*
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Format: (000) 000-0000.
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- Preferred Contact Method*
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- Are you the legal parent or legal guardian of every child included?*
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- Adult 1 date of birth*
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- Adult 1 employment status*
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- Adult 1 income sources*
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- Adult 2 date of birth
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- Adult 2 employment status
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- Adult 2 income sources
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- Adult 3 date of birth
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- Adult 3 employment status
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- Adult 3 income sources
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- Child 1 date of birth*
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- Child 2 date of birth*
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- Child 3 date of birth*
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- Child 4 date of birth*
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- Child 5 date of birth*
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- Child 6 date of birth*
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- Can you provide a formal custody or guardianship document?*
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- Are you requesting Christmas gifts?*
- Are you requesting food assistance?*
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- Have you applied for, registered for, or received Christmas assistance from another organization, agency, church, school, community group, charity, Christmas program, or similar program for this Christmas season?*
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- Date applied
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- Declarations*
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- Date signed*
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- Should be Empty: