The Birthday Bundle "Because Birthdays Matter Too!" If you are a food pantry client and would like to receive a "Birthday Bundle" for children ages 1-17 living in your home , please fill out this form.

You may choose 2 age appropriate toys/gifts from our inventory. You may also give me a wishlist of ideas for your child in the comments section below.

You may put in a request 3 months in advance of the upcoming birthday to allow time to get everything together. You will be notified by email or phone when the bundle is ready for pickup.

Parent or Guardian's Name *

Full Address *

Please provide email or phone number. *

Child's Name *

Child's Gender *

Male

Female

Age Child is Turning on their birthday: *

Child's Date of Birth * +

Are you currently a food pantry client? *

Yes

No

Eligibility for "The Birthday Bundle" is based on the below income requirements or participation in SNAP, WIC, or SSI.

This institution is an equal opportunity provider.

This table shows a gross income for each household size
Based on 200 Percent Federal Poverty Income Guidelines
Household Size	Annual	Monthly	Weekly
1	$30,120	$2,510	$579
2	$40,880	$3,407	$786
3	$51,640	$4,303	$993
4	$62,400	$5,200	$1,200
5	$73,160	$6,097	$1,407
6	$83,920	$6,993	$1,614
7	$94,680	$7,890	$1,821
8	$105,440	$8,787	$2,028
For each additional family member add	$10,760	$897	$207

Please check how you are eligible *

Income guidelines (see chart above)	SNAP	WIC
SSI

Please pick 2 age appropriate items/gifts. You may also give me a list of ideas in the comment section below.

Please tell me anything about your child that would be helpful for the bundle. Be specific as possible. ( Total of gifts will be a maximum of $50 per child)