Giving Tree Application

This application for Christmas assistance may be submitted for any child (under the age of 18 during 2016) whose permanent residence is in the state of Kentucky, who is suffering from a Congenital Heart Defect. Siblings of a child suffering from CHD are also eligible under the same application. Receiving applicants will be contacted with a date and time to pick up their gifts

PLEASE COMPLETE ENTIRE APPLICATION

You will need to email the following documents to info@kerringtonsheart.org in addition to completing the information below to be considered. Incomplete application will not be considered.

1. A valid photo ID of the applicant
2. Proof of income (most recent pay stub for mother and father of the child)
3. Proof of residence (most recent utility bill or bank statement with current address) 4. Proof of housing expense (most recent mortgage or rent statement) 

Applicant Name *
Applicant Name
Phone
Phone
Applicant's Address
Applicant's Address
Child 1 (CHD Child)
CHD Child Date of Birth
CHD Child Date of Birth
When was their last hospitalization?
When was their last hospitalization?
(i.e. type of clothing or other need)
(i.e, specific toy or game)
Child 2 (Sibling)
Sibling Date of Birth
Sibling Date of Birth
Child 3 (Sibling)
Child 3 Name:
Child 3 Name:
Child 3 Date of Birth
Child 3 Date of Birth
Child 4 (Sibling)
Child 4 Name:
Child 4 Name:
Child 4 Date of Birth
Child 4 Date of Birth