Holiday Campaign 2020 Please enable JavaScript in your browser to complete this form.Applications must be received no later than Friday, November 18th. Gift cards will be distributed December 5th through December 9th only. There will be no gift cards available after December 9th. Name *FirstLastAddress *Address Line 1Address Line 2City--- Select state ---AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingStateZip CodeHome Phone *Cell Phone *Work Phone *Email *Relationship to Child/Children *ParentLegal GuardianOtherIf other, please specifyNumber of children under the age of 18 *Please list the names, birth dates, and grade level of each child. (Example: John Smith, 5/25/2015, 1st Grade) *Please upload a proof of residency dated within 30 days (Example: utility bill or Rent/Mortgage Statement). Click or drag a file to this area to upload. Please note, a proof of residency is required to participate in the holiday campaign. If you are unable to upload a copy of your proof of residence, please contact East Haddam Youth & Family Services at 860.873.3296.Release of InformationI give my permission to the East Haddam School system to confirm my child/children's enrollment with East Haddam Youth & Family Services. I understand that this is part of my application for participation in the EHYFS Holiday Campaign.I have read the above release and consent to have my child's enrollment confirmed by the East Haddam School system. *YesSignatureParents/guardians will be notified when their gift cards are ready for pick-up.NameSubmit