CHRISTMAS ASSISTANCE FORM

Please fill out the form below.

Have you or anyone in your household applied for or requested Christmas assistance at any other organization this year?

Yes

Do all of your children listed below live at the address listed above full time?

Yes

Please fill out the box below with the Child's Name, Age, Sex, School, Shoe Size, Pant Size, Wish List, Relation to you. In that order. If you have multiple children number them accordingly (example 1. Child Name, Age, Sex, etc. then 2. Child Name, Age, Sex, etc.

COMPLETION OF THIS APPLICATION DOES NOT AUTOMATICALLY GUARANTEE THAT YOUR FAMILY WILL BE SELECTED.
To ensure that as many families as possible get an opportunity to take advantage of the program, we must take into consideration the number of times your family has received assistance in the past years. However, this will not automatically disqualify your family from receiving it again this year.
Applications are NOT selected on a first-come, first-serve basis.
We work closely with other organizations in Blackford County to cross-check family's names to ensure there is no duplicate of services

Thanks for submitting!

Our organization is blessed to serve families in hard times at Christmas each year. However, if we have served your family for two years, we ask that if you need help a third year that you reach out to other organization in Hartford City so that we may be able to serve others that may need help.