2023 Community Table/Northmont FISH Christmas Gift Assistance Registration If your family needs assistance providing gifts for your children this Christmas, please complete the attached form. All participants must be registered, and families must be Northmont Residents (unless the family is an active member of one of the Community Table Churches.) Applications are only accepted from custodial parent(s) or legal guardian. Children up to age 19 are eligible. (age 21 if in college and living at home.) Please complete the following information carefully. Please indicate the child’s name, age and gender. Applications must be turned in by November 17, 2023. Complete and return form electronically or print, complete and return form to: Northmont FISH 265 Smith Drive Englewood (drop in the black mailbox by the front door), Community Table Christmas Store, c/o Salem Church of God, 6500 Southway Dr. Clayton, Ohio 45315, or Northmont School Board Office 4001Old Salem Rd, Englewood. We will not be able to serve anyone who is not registered. YOU WILL BE CONTACTED WITH A DATE AND TIME FOR YOU TO SHOP FOR YOUR FAMILY. Shopping hours will be during the week of December 4 thru 9, 2023. * ALSO NOTE: Several organizations in our community assist us by adopting families! It is possible that your family may be adopted by another organization. Either way, you will be contacted with further information. Keep the following numbers in your contact list so you recognize them when you are called! Community Table Christmas Store Number is 937-830-9428 Northmont FISH 937-836-4807 KEEP THIS TOP PORTION FOR YOUR REFERENCE!! ********************************************************************************** Parent’s Last Name________________________ First Name___________________________________ Address____________________________________________________________________________
City_______________________________________________ Zip________________ Best phone number _______________________ Email Address _____________________________ Phone Number: (Please give the BEST phone number where you can be reached to schedule your appointment time. Christmas Store Contact Number is 937-830-9428. Northmont FISH 937-836-4807. Please respond to calls from these numbers so we can give you further information.) ***Total number of Children you are registering: __________________________ 1. Child’s full name___________________________________________________ Age _________________________Gender _______________________ 2. Child’s full name__________________________________________________________________ Age _________________________Gender _______________________ 3. Child’s full name__________________________________________________________________ Age _________________________Gender _______________________ 4 Child’s full name__________________________________________________________________ Age _________________________Gender _______________________
*Add information for any additional children on the back of this form.