Christmas 2022

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The Family Resource Center of the Tri-Cities

Desert Harbor Youth & Teen Center

Christmas 2023

Full name First & Last Name:

Home Address: (Address, City, State, Zipcode)

Phone (where you can receive a text)

Who is submitting application?

Self

Social Worker

School Counselor

Agency

Other

These are the items you will need apply: (please make sure to have all these items ready before you're appointment)

Proof of income (one months worth)

Proof of Address (no personal letters accepted)

Picture ID for ALL Adults

Medical ID Cards and/or Birth Certificates

How many kids do you have?

How many kids with special needs do you have? (N/A if it doesn't apply. We take familie who have kids with special needs first)

I agree that I will not apply at another Christmas Program. I understand it will disqualify me if I do.

Tell us about your child with special needs: (you will need to bring in documentation that lists the diagnoses)

Please choose how you would like to get notification about an appointment. Time is running our and we have until December8th to get in to apply

I would like to receive a text about an appointment

I would like to receive an email for my appointment

This program is ONLY FOR FAMILIES that hav a child(ren) Diagnosed with a disability.

Thanks for applying! We will see you at the time and date you have selected. No other appointment slots will be available.

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