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 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 so I can contact you when the bundle is ready. *

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, lunch program at school 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 *

Please click on categories your child has interest in. You may also give me a list of ideas in the comment section below.

Please provide a wishlist for gift ideas (Not to exceed $50 per child). Be sure to include favorite characters or shows, favorite color or theme preferences and general interests.

Income guidelines (see chart above)	SNAP	WIC
SSI	lunch program at school