Santa’s Toy Chest Application:
Please complete ALL information and return in person by *Nov. 20, 2020.
No late applications accepted!
Please bring in the following when turning in application:
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1. Valid Florida state issued ID or Driver’s License
2. Valid Proof of Residence – Tax Bill, Lease, Voter’s Registration card are acceptable
3. Valid current utility bill
4. Proof of Income
5. Birth Certificates for any child ages 1 thru 12 in home.
*Turn in times are Monday, Tuesday, Thursday & Friday from 2pm – 6pm
Parent/Guardian Name: _____________________________________________________________
Parent/Guardian Address: ___________________________________________________________
____________________________________________________________
Parent/Guardian Phone: Home __________________ Cell__________________________________
(We must be able to contact you if application is accepted.)
Total # in Household_________
Names of those aged 1 – 12 in Home:
NameAgeM/FBirth Certificate
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
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Employment and Income
Employer: ______________________________
Phone #: _______________________________
Net pay total for last month: ________________
*(must provide at least 2 pay stubs within 30 days prior)
Employer: ______________________________
Phone #: _______________________________
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Net pay total for last month: _______________
*(must provide at least 2 pay stubs within 30 days prior)
Anyone in home active_________ or retired military___________?
Do you or anyone in the home receive any other assistance? ________
*(please provide statement/form from any agency with amount that you or anyone in home receive)
If yes, please list below:
1) From: ______________________
Amount: ____________________
2) From: ______________________
Amount: ____________________
3) From: _____________________
Amount: ____________________
If approved, preferred pick-up date and time (please check one provided)
Monday 12/14 3pm - 6pm ______
Tuesday 12/15 1pm - 4pm ______
*All information provided above must have documents to verify.
Signed: ___________________________ Date: ________________
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Pick-up signature ____________________________________ Date _________________________________
__________________________________________________________________________________________
MCC received (date): _____________ by (name): _________________________________________
MCC copies rec’d and verified by: _____________________________________________________
Approved: _____________ Not approved (reason): ______________________________________
Applicant called by: ___________________ Pick-up day/time: _______________________________
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Pick-up signature ________________________________