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CHRISTMAS FOR KIDS 2008
LAST NAME: FIRST:
MARITAL STATUS: SINGLE SEP MARRIED DIV WIDOW(ER)
ADDRESS:
OCCUPATION: EMPLOYER: HOW LONG?
TELEPHONE: HOME: WORK: OTHER:
CHILDREN: AGE: GIRL/BOY:
1.
2.
3.
4.
5.
OTHERS IN HOUSEHOLD: NAME AND RELATIONSHIP
IS WINTER CLOTHING NEEDED? (IF SO, WHAT ITEMS AND SIZES)
PLEASE GIVE A SHORT SUMMARY OF WHY YOU ARE APPLYING FOR GIFTS (JOB LOSS, ETC.)
PARENT/GUARDIAN SIGNATURE: DATE:
AGE LIMIT IS NEWBORN THROUGH 12 YEARS OLD.
PLEASE RETURN THE COMPLETED APPLICATION BY DECEMBER 19, 2008 TO THE TOWN HALL, AT EITHER THE BOARD OF SELECTMEN’S OFFICE
OR WITH PEG TATRO, WELFARE DIRECTOR.
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