"THE EXPERIENCE 2024" COMMUNITY CHRISTMAS CELEBRATION

IMPACT Community Services Corporation is hosting the annual Christmas Community Celebration, "The Experience," on Saturday, December 14, at 10:00 am at Bible-Based Fellowship Church, Bldg. 1, 4811 Ehrlich Road, Tampa, FL 33624. We look forward to hosting families from our communities with Christmas caroling, children's activities, wrapped Christmas toys for youth (grades K-5), bagged groceries, and a hot meal on the premises. We invite you to nominate a family or your own to participate as a recipient. The registration period is extended - complete the form and submit it by Friday, November 15, 2024.

School Name *

Parent or Guardian's Name *

Street Address *

City *

State *

Zip Code *

Phone Number *

Email Address *

Do you receive public assistance? (Check all that apply) *

SNAP

WIC

TANF

Other

BY SIGNING BELOW, I UNDERSTAND THAT COMPLETING THE APPLICATION DOES NOT GUARANTEE THE RECEIPT OF ANY GIFTS OR FOOD BOXES AND THAT THE QUALITY AND QUANTITY OF THE GIFTS IS DEPENDENT UPON THE GENEROSITY OF THE DONORS. I HEREBY GIVE PERMISSION TO RELEASE THIS INFORMATION TO ANOTHER GROUP OR PERSON FOR ASSISTANCE OR VERIFICATION OF INFORMATION. *

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PROVIDE THE INFORMATION BELOW FOR UP TO FOUR CHILDREN (GRADES K-5). YOU MAY BE REQUIRED TO PROVIDE PROOF OF PARENTHOOD/GUARDIANSHIP AND DATE OF BIRTH.

NAME *

GENDER *

GRADE *

NAME

GENDER

GRADE

NAME

GENDER

GRADE

NAME

GENDER

GRADE

Completed applications are due no later than Friday, November 15, 2024. If you download this form to complete it manually, you may submit it to the BBFC Admin Office. The point of contact is Julianne Corker, 813-362-8642 - email: julianne.stitt@gmail.com or Dr. Rowevina Herring, 571-309-7719, email: rowevina.herring@impactcscfl.org.