Christmas Application Step 1 of 5 20% Participation in this program is limited and will be filled on a first come, first served basis. Please allow two full weeks to HCC Staff to process all applications. At the end of this application you will be asked to upload the following documents. Please be prepared with pdf, png, gif or jpg copies of these files. A hand written letter stating your current situation A copy of each child's birth certificate OR proof of guardianship (NO SSN CARDS) A copy of your valid photo ID A copy of your most current electric bill or most current phone bill with your current address Tax return or check stub (if possible) A copy of food stamps award letter, Medicaid letter, or any other form of government assistance award letters (if possible) IMPORTANT! PLEASE READ: WE WILL NOT ACCEPT SSN CARDS. Participation in this program is limited and will be filled on a first come, first served basis. Upon receipt of COMPLETE application and documentation, you will receive an appointment date in early December via mail or email. If your contact information changes (phone number or address), please call our office to update your information. By submitting this form you also agree to allow pictures of you and/or your children in any HCC publication. By submitting this form you agree to HCC’s Waiver & Release of Liability, Assumption of Risk, and Indemnity Agreement located on houstonchildrenscharity.org/waiver/ Incomplete and Walk-in applications WILL NOT be accepted. EMAIL WILL NOT BE ACCEPTED.Contact InformationParent Name* First Last Spouse Name First Last Initials*Enter your initials to indicate you have read and agree to this waiver. Address* Street Address Address Line 2 City State AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific ZIP Code Email* Enter Email Confirm Email Home PhoneCell Phone*Work PhoneExtension Additional InformationMarital Status*MarriedSingle ParentDivorcedSeperatedLiving TogetherLanguage*EnglishEnglish/SpanishMonthly Household Income*Please include any government assistance. Rent Amount*What is your monthly household income, including any government assistance? Please list your children's information below:PLEASE LIST ALL CHILDREN UNDER YOUR CUSTODY. Children not biologically related, without custody paperwork will NOT BE APPROVED.Did you apply for Back2School this year?*(If yes, please only list additional children below) Yes No How many children are in your Legal Custody?*12345678Child #1* First Last Age*0-12345678910111112131415161718Birth Date* MM slash DD slash YYYY Gender*MaleFemaleChild #2* First Last Age*0-12345678910111112131415161718Birth Date* MM slash DD slash YYYY Gender*MaleFemaleChild #3* First Last Age*0-12345678910111112131415161718Birth Date* MM slash DD slash YYYY Gender*MaleFemaleChild #4* First Last Age*0-12345678910111112131415161718Birth Date* MM slash DD slash YYYY Gender*MaleFemaleChild #5* First Last Age*0-12345678910111112131415161718Birth Date* MM slash DD slash YYYY Gender*MaleFemaleChild #6* First Last Age*0-12345678910111112131415161718Birth Date* MM slash DD slash YYYY Gender*MaleFemaleChild #7* First Last Age*0-12345678910111112131415161718Birth Date* MM slash DD slash YYYY Gender*MaleFemaleChild #8* First Last Age*0-12345678910111112131415161718Birth Date* MM slash DD slash YYYY Gender*MaleFemale Please Provide the Following Documents:A hand written letter stating your current situation* Drop files here or Select files Accepted file types: jpg, jpeg, pdf, gif, png, doc, docx, Max. file size: 300 MB. A copy of each child's birth certificate*(OR proof of guardianship (NO SSN CARDS) Drop files here or Select files Accepted file types: jpg, jpeg, pdf, gif, png, doc, docx, Max. file size: 300 MB. A copy of your valid photo ID* Drop files here or Select files Accepted file types: jpg, jpeg, pdf, gif, png, doc, docx, Max. file size: 300 MB. A copy of your most current electric bill or most current phone bill with your current address.* Drop files here or Select files Accepted file types: jpg, jpeg, pdf, gif, png, doc, docx, Max. file size: 300 MB. Tax return or check stub(if possible)Accepted file types: jpg, jpeg, pdf, gif, png, doc, docx, Max. file size: 300 MB.AdditionalA copy of food stamps award letter, Medicaid letter, or any other form of government assistance award letters (if possible)Accepted file types: jpg, jpeg, pdf, gif, png, doc, docx, Max. file size: 300 MB. Ready to SubmitCaptcha Δ