Volunteers serving the needs of northern Anoka County, MN

Christmas Committee

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Distribution Site Map

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ONLINE APPLICATION FORM

For online application for services from the Christmas Committee.

"*" indicates required fields

How many people in your household?*

Please enter a number greater than or equal to 1.

Your Email*

Your Name*

First Last

Your Birth Date*

Month

Day

Year

Partner's Name

First Last

Partner's Birth Date

Month

Day

Year

Address*

Street Address Apartment/Unit City ZIP / Postal Code

North Anoka County ONLY. Cities Served: Andover, Anoka, Coon Rapids, Bethel, Blaine, Burns, Cedar, Circle Pines, East Bethel, Ham Lake, Lino Lakes, Nowthen, Oak Grove, Ramsey, St. Francis, Stacey, and Wyoming

Phone with area code*

REQUIRED: Check Here to Get An Appointment*

Check to indicate you will need to have an ID and that this check substitutes for your signature on this application when you arrive at our site for your appointment.

REQUIRED: Permission to share your information*

Check to agree that: 1. Your information may be used with other groups giving food and toy help. 2. Other systems may be used to check that your information is correct. 3. Other groups may be informed that you applied with Christmas Committee.

CHILDREN IN YOUR CUSTODY (YOU MAY NEED PROOF OF CUSTODY). Include a "Wish list" of types of toys, games, books, etc. TO ADD CHILDREN CLICK PLUS SIGN (+) ON THE RIGHT.

Child's Name

Age

Gender

"Wish list" gift details up to $35 per child: toys, games, books?

*** TO ADD MORE CHILDREN CLICK THE PLUS SIGN (+) ***

CHECK THIS BOX ONLY IF YOU ARE HOMEBOUND DISABLED AND NEED HOME DELIVERY

Request Home Delivery

There must be a person at your home on distribution day to accept delivery.

REQUIRED: CHECK HERE AFTER ENTERING ALL FAMILY INFORMATION.*

Include information for ALL CHILDREN (if any).

I have entered all family information

Phone

This field is for validation purposes and should be left unchanged.