The Birthday Bundle "Because Birthdays Matter Too!" For Food Pantry clients. Please choose 2 items/gifts from below

If you would like to receive "The Birthday Bundle" for children living in your home ages 0-16, please fill out the information below. Please give us at least a week in advance to be able to gather all supplies.

Parent or Guardian's Name *

Full Address *

Child's Name *

Child's Gender *

Male

Female

Child's Date of Birth * +

Age Child is Turning on their birthday: *

Are you a current food pantry client? *

Yes

No

Eligibility for "The Birthday Bundle" is based on the below income requirements or participation in SNAP, WIC, or a child receives free/reduced meals at school.

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	$29,160	$2,430	$561
2	$39,440	$3,287	$758
3	$49,720	$4,143	$956
4	$60,000	$5,000	$1,154
5	$70,280	$5,857	$1,352
6	$80,560	$6,713	$1,549
7	$90,840	$7,570	$1,747
8	$101,120	$8,427	$1,945
For each additional family member add	$10,280	$857	$198

Please check how you are eligible *

Income guidelines (see chart above)	SNAP	WIC
Child receives free/reduced meals at school.

These are general items with no pictures. Some of the items pop up another list if clicked on with more detail of items that may be available. (You will have to scroll down to the bottom)