Christmas form


Family Application

Please Provide: Valid ID, Birth Certificate for each child, Current Utility Bill

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Child Home & Relationship to Head of Household

C - Child G -Grandchild N -Niece/Nephew O -Orphan

Adults Living in Home

Monthly Income

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

Additional Children (If Applicable)

Program Participation and Exclusivity Agreement


By submitting this application, I acknowledge and agree that participation in this program is exclusive. If I apply for, enroll in, or accept participation in another similar or competing program while my application is under consideration or while I am actively participating in this program, I understand that I may be disqualified and will forfeit my eligibility and participation in this program.


I understand that submitting an application to this program signifies my commitment to its requirements, guidelines, and terms of participation.


Hold Harmless and Release of Liability Agreement


I acknowledge that my participation in this program is voluntary and that I am responsible for providing accurate information and complying with all program guidelines and requirements.


To the extent permitted by applicable law, I agree to release, indemnify, and hold harmless the program, its owners, administrators, employees, representatives, and affiliates from claims, liabilities, damages, or expenses arising out of my participation in the program, except to the extent caused by their negligence, gross negligence, willful misconduct, or other conduct for which liability cannot legally be waived.


I understand that I am responsible for my own decisions, actions, and compliance with the program requirements. I acknowledge that I have read, understood, and voluntarily agreed to these terms.