Registrations

Please Provide: Valid ID, Proof of Income, Proof of the age of the child, and proof you are the parent or legal guardian.

Christmas Shop Application

All fields marked * are required.

Have you applied for or received any assistance from another organization?

YesNo

Household Information

Head of Household *

Date of Birth

Spouse Name

Spouse Date of Birth

Phone *

Work Phone

Email *

Address

City

Zip Code

Children

Note: Please list accurate clothing and shoe sizes. You will not be able to change sizes upon arrival.

Child 1

Child Name

M/F

Relations

DOB

Age

Clothing Size

Shoe Size

Monthly Income

Monthly Job Income

Employer's Name

Disability Income

SSI Income

TANF

Child Support

Unemployment

Other

Proof of Documents

Please upload copies of: Valid ID, Proof of Income, Proof of child's age, and Proof of guardianship. Accepted formats: JPG, PNG, PDF (max 10MB each, up to 5 files).

Click to upload or drag and drop files here

Up to 5 files

Additional Information

Referred By

Additional Notes

All the information I have provided is true and correct to the best of my knowledge.