2010 Gifts for Kids Program
Application for Gifts
This application is being completed for the 2010 Bloomer Area Gifts for Kids Program. By completing this application you so state that you are not enrolled in
or will be enrolling in any other type of Christmas Gift programs for yourself and/
or your family. The gifts that you will receive will be gifts for your children and
yourself and will not be used for gifts to others or for resale.
This program has been developed to aid Parents of children in the Bloomer Area,
and can only be used by one parent (we are sorry but Grand Parents do not apply).
This program has been designed with your discretion in mind, however you must use Children’s and Parents real names. These forms will only be viewed by 2 people
and names will be kept confidential.
All forms will be reviewed and if any information is found to be false you will not
qualify.
*** All Gifts MUST be picked up by the Parent completing this application--you
will be required to show a picture ID at the time of pick-up.
PLEASE COMPLETE THE ATTACHED GIFT FORM
Your Signature____________________________________ Dated_______________
Address:_______________________________________________________________
_______________________________________________________________
Phone number:________________________ Second Phone:____________________
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PLEASE KEEP THIS PORTION FOR GIFT PICK-UP!
Gift Bag Number #____________________
Gift bags may only be picked up by the Parent listed above.
Please be on time, if you have questions, call Rod at 568-3339 or 568-2687
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Gifts for Kids program 2010 Bag # _________
By signing this form you attest that you, your spouse, other family members, your children’s parents or friends have not applied for or will be receiving any type of other help involving clothing or toys etc this Holiday Season. You also attest that all information that you supplied our office when applying for the “Gifts for Kids” program is true and accurate.
Dated: ___________________________________
Signed: ___________________________________
___________________________________
Office________________________________
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Your Sponsor was: ______________________________________
______________________________________
______________________________________
______________________________________
______________________________________
We ask that you please send a Thank You note to your sponsor.
You do not have to give your Identity when sending the card!
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Bloomer Area “Gifts for Kids”
Program 2010
I _____________________________________, hereby state that I am not involved with,
(Name)
Nor have I applied for or will be receiving any other assistance from any other type of program
Involving gifts for children. I further state that the gifts I am receiving are for my own children
And are not being used as gifts for others or for resale.
Name: ______________________________________________
Address: ____________________________________________
___________________________________________________
Phone: _____________________________________________
Signature: __________________________________________
“Gifts for Kids” Witness: ______________________________
Dated: _____________________________________________