Christmas 2026

Apply for Assistance

Parents / Guardians

Family last name *

Mother/Guardian — first name

Mother/Guardian — last name

Mother/Guardian — SSN (last 4)

Father/Guardian — first name

Father/Guardian — last name

Father/Guardian — SSN (last 4)

Delivery address

Where the gifts will be delivered.

Address *

Address line 2 (Building name or apartment number)

City *

State *

Zip *

Contact

Cell phone *

Alternate phone 1

Alternate phone 2

Email (optional)

If you give one, we'll email your application confirmation here.

Children

Enter each child in your household.

Girls

First name

Last name

Date of birth

SSN (last 4)

First name

Last name

Date of birth

SSN (last 4)

First name

Last name

Date of birth

SSN (last 4)

First name

Last name

Date of birth

SSN (last 4)

First name

Last name

Date of birth

SSN (last 4)

First name

Last name

Date of birth

SSN (last 4)

Boys

First name

Last name

Date of birth

SSN (last 4)

First name

Last name

Date of birth

SSN (last 4)

First name

Last name

Date of birth

SSN (last 4)

First name

Last name

Date of birth

SSN (last 4)

First name

Last name

Date of birth

SSN (last 4)

First name

Last name

Date of birth

SSN (last 4)

Leave unused rows blank. More than 6 girls or 6 boys? Please contact our office: 249 W Clinton St, Elmira, NY 14901 · (607) 733-4576 · info@arcticleague.com