Lincoln County Toy Drive
Benefiting Children Up to the Age of 12
Fayetteville Fire Department – The Elk Valley Times – Fayetteville Rotary Club
Child/Children Information
Child {binding ItemNumber}
Name of Child {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{binding displayValue}
Social Security Number {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{binding displayValue}
Age {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{binding displayValue}
Parent/Guardian Information
Name of Parent(s) or Legal Guardian(s) {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{binding displayValue}
Social Security Number {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{binding displayValue}
Date of Birth {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{binding displayValue}
Name of Parent(s) or Legal Guardian(s) {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{binding displayValue}
Social Security Number {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{binding displayValue}
Date of Birth {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{binding displayValue}
Street Address of Parent(s) or Legal Guardian {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{binding displayValue}
Phone Number of Parent(s) or Legal Guardian {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{binding displayValue}
If You Are Not Parent/Guardian, Your Name {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{binding displayValue}
If You Are Not Parent/Guardian, Your Phone {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{binding displayValue}
If you are not the parent/guardian, please describe why this family needs assistance: {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
**SPECIAL NEEDS CHILDREN** Notes Regarding Special Needs Children: {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
Total Household Income Per Month {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{binding displayValue}
Source(s) of Income/Employer (Please include Food Stamps, Families First, SSI, Child Support, etc.) {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
I give my permission for The Elk Valley Times to contact the Department of Human Services to release any information about my household. (This information will only be used for the purposes of the toy drive.)
Signature {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
All applicants won’t necessarily receive toys, but if you do not pass the screening, you will be contacted by Dec. 9.
If you are not contacted, you can pick up your toys Wednesday, Dec. 23, between 9 a.m. and 3 p.m. on the parking lot at Fayetteville High School, 1800 Wilson Parkway.
Please remain in your vehicle as you drive through the site. The deadline to submit an application is Friday, Dec. 4.