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 }
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Is this Child Male or Female? {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
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Parent/Guardian Information

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Name of Parent(s) or Legal Guardian(s) {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
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Street Address of Parent(s) or Legal Guardian {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
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If You Are Not Parent/Guardian, Your Name {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
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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.)

{ 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.

 

Lincoln County Toy Drive

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}
{ binding firstError.message }
Social Security Number {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
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{ binding firstError.message }
Age {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
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Is this Child Male or Female? {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
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Parent/Guardian Information

Name of Parent(s) or Legal Guardian(s) {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{binding displayValue}
{ binding firstError.message }
Social Security Number {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
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Date of Birth {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
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Name of Parent(s) or Legal Guardian(s) {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{binding displayValue}
{ binding firstError.message }
Social Security Number {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
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Date of Birth {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{binding displayValue}
{ binding firstError.message }
Street Address of Parent(s) or Legal Guardian {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
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Phone Number of Parent(s) or Legal Guardian {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
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If You Are Not Parent/Guardian, Your Name {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
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If You Are Not Parent/Guardian, Your Phone {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
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If you are not the parent/guardian, please describe why this family needs assistance: {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
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**SPECIAL NEEDS CHILDREN** Notes Regarding Special Needs Children: {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
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Total Household Income Per Month {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
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Source(s) of Income/Employer (Please include Food Stamps, Families First, SSI, Child Support, etc.) {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
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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 }
{ 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.