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Aplicación de bolsa

Siouxland parents and guardians seeking assistance to provide their children with gifts at Christmas time should fill out this application and register with Goodfellow Charities, Inc.

DEADLINE FOR ALL APPLICATIONS: November 30, 2025
*After submission, if you don't receive a confirmation email, please check your 'SPAM' folder.

Today's Date

* required

Parent / Guardian Information
ONLY ONE APPLICATION PER FAMILY WILL BE ACCEPTED.

Parent / Guardian First Name

Parent / Guardian Last Name

Home address

City

State

Zip Code

Phone Number

Child Information
DO NOT INCLUDE CHILDREN OVER THE AGE OF 12.

Total number of children under the age of 12 *

1 child

2 children

3 children

4 children

5 children

More than 5 children

If more than 5 children, designate the total number of children:

Boy Information

Number of Boys: * Obligatorio

0 - No boys

1 boy

2 boys

3 boys

4 boys

5 boys

More than 5 boys

If more than 5 boys, designate the total number of boys:

Select the age range for each boy: * Obligatorio

0-1 years old

2-3 years old

4-5 years old

6-7 years old

8-9 years old

10-12 years old

Please share if any boys are the same age:

Girl Information

Number of Girls: * Obligatorio

0 - No girls

1 girl

2 girls

3 girls

4 girls

5 girls

other

If more than 5 girls, designate the total number of girls:

Select the age range for each girl: * Obligatorio

0-1 years old

2-3 years old

4-5 years old

6-7 years old

8-9 years old

10-12 years old

Please share if any girls are the same age:

Certification of Accuracy

I hereby certify that the information provided in this form is true, complete, and accurate to the best of my knowledge. I understand that any false or misleading information may result in disqualification or other administrative actions.

I acknowledge and agree to the above statement. *After submission, if you don't receive a confirmation email, please check your 'SPAM' folder.

Please review the information.

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Buen compañero Aplicación de bolsa