Application for

Spread The Cheer USA

Holiday Assistance

Choose One

I am applying on behalf of another person/family.

I am applying for myself and/or my family.

Family Information (Household)

Parent/guardian first name:

Parent/guardian last name:

Phone

Home Address

City

State

Zip code

Preferred method of contact

Phone

Text

Preferred language for communication:

Household Members

Number of people in household

Household Information

To help us determine eligibility and prioritize assistance for families most in need, we kindly ask that you provide your total household income, this income is kept strictly confidential and is used solely for the purpose of evaluating applications for Christmas assistance.

Total household income (monthly or annually)

I prefer not to disclose (Note: This may effect eligibility)

What would you like to share about the household's current situation or any special circumstances:

Media & Privacy Permissions

Permission is given for Spread The Cheer USA to use photos and/or videos taken during delivery for marketing, promotional or social media purposes.

Permission is not given for media use.

If selected, volunteer elves will arrange delivery of the gifts prior to Christmas. Please select the delivery option that works best for you:

The gifts can be delivered to the household home, and the family will open on delivery day.

The gifts can be delivered to the household home but would prefer to open the gifts on Christmas day and will provide photos and videos to Spread The Cheer USA (if permission was granted).

Delivery will need to take place at a separate location different from the household home. (must be approved by STC prior to delivery)

**Disclaimers & Agreements

I understand that submitting this form does not guarantee my family or the referred family will be selected as a recipient.
I acknowledge that Spread The Cheer USA and its volunteers are not responsible for any accidents, injuries, or damages that may occur during the delivering of gifts.
I understand that Spread the Cheer USA is not responsible for any use or misuse of gifts received through the campaign. All items are provided "as is" without any guarantees or warranties.
I give permission for my family's wish list and relevant personal information provided to be shared with approved volunteers for the purpose of gift fulfillment.
I affirm that the information provided in this form is true and accurate to the best of my knowledge.
I agree to be contacted by Spread The Cheer USA for follow-up or delivery coordination.

Do you agree to the disclaimers and Agreements?

Yes

Signature

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Date

Month

Day

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