Toys for Tots - Waitlist

TOYS FOR TOTS WAITLIST REGISTRATION FORM

Parental Information

I hereby certify that I live in Hall, Hamilton, Howard or Merrick County in NEBRASKA

Hall

Hamilton

Howard

Merrick

I do not live in Nebraska

Only Nebraska residents are eligible for this program.

You must live in Hall, Hamilton, Howard or Merrick Counties in Nebraska apply.

How did you hear about Toys for Tots?

Sorry, only residents of Nebraska are eligible for this program.

Parent 1

Parent 1 First Name

Parent 1 Last Name

Street Address

City

State

Postal Code

Phone

Email Address (this is where you will receive information about your application, as letters will not be mailed to you).

Parent 2

Parent 2 First Name

Parent 2 Last Name

Street Address

City

State

Postal Code

Phone

Child #1

Child 1 First Name

Child 1 Last Name

Gender

Age

School

Name of Other location

Currently lives with Parent 1

Yes

Currently lives with Parent 2

Yes

Special Needs Toys

Yes

Do you have another child?

Yes

Please explain

Child #2

Child 2 First Name

Child 2 Last Name

Gender

Age

School

Name of Other location

Currently lives with Parent 1

Yes

Currently lives with Parent 2

Yes

Special Needs Toys

Yes

Do you have another child?

Yes

Please explain

Child #3

Child 3 First Name

Child 3 Last Name

Gender

Age

School

Name of Other location

Currently lives with Parent 1

Yes

Currently lives with Parent 2

Yes

Special Needs Toys

Yes

Do you have another child?

Yes

Please explain

Child #4

Child 4 First Name

Child 4 Last Name

Gender

Age

School

Name of Other location

Currently lives with Parent 1

Yes

Currently lives with Parent 2

Yes

Special Needs Toys

Yes

Do you have another child?

Yes

Please explain

Child #5

Child 5 First Name

Child 5 Last Name

Gender

Age

School

Name of Other location

Currently lives with Parent 1

Yes

Currently lives with Parent 2

Yes

Special Needs Toys

Yes

Do you have another child?

Yes

Please explain

Child #6

Child 6 First Name

Child 6 Last Name

Gender

Age

School

Name of Other location

Currently lives with Parent 1

Yes

Currently lives with Parent 2

Yes

Special Needs Toys

Yes

Do you have another child?

Yes

Please explain

Child #7

Child 7 First Name

Child 7 Last Name

Gender

Age

School

Name of Other location

Currently lives with Parent 1

Yes

Currently lives with Parent 2

Yes

Special Needs Toys

Yes

Do you have another child?

Yes

Please explain

Child #8

Child 8 First Name

Child 8 Last Name

Gender

Age

School

Name of Other location

Currently lives with Parent 1

Yes

Currently lives with Parent 2

Yes

Special Needs Toys

Yes

Do you have another child?

Yes

Please explain

Child #9

Child 9 First Name

Child 9 Last Name

Gender

Age

School

Name of Other location

Currently lives with Parent 1

Yes

Currently lives with Parent 2

Yes

Special Needs Toys

Yes

Do you have another child?

Yes

Please explain

Child #10

Child 10 First Name

Child 10 Last Name

Gender

Age

School

Name of Other location

Currently lives with Parent 1

Yes

Currently lives with Parent 2

Yes

Special Needs Toys

Yes

Please explain

Signature is validation of the information provided and an agreement of the rules of this program. By completing this form you understand that this is a wait list application, and submitting this form does not deem automatic eligibility and acceptance. Once submitted, applications are verified.

Sign above

(security question) What color is the sky?