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2018 Bus Jam Toy Registration
You will not be receiving a call unless you filled out the information about special needs or transportation.

On Bus Jam Saturday December 8, 2018, come to the Boys and Girls Club, 3333 Walnut Ave., Coos Bay starting at 8:30AM.

When you come to the Bus Jam Distribution, bring the following information with you:

* IDENTIFICATION
* PROOF THAT CHILDREN LIVE WITH YOU (DHS print out, OHP card or anything with the child's name and their address)
* CHILDREN CANNOT ATTEND THIS EVENT WITH YOU
* A COPY OF THE EMAIL YOU RECEIVE FROM THIS REGISTRATION

Bus Jam Toy & Food Drive Distribution Form
What is your Email? *
Your answer
What is your Phone Number? *
Your answer
What is your Full Name? *
Your answer
I am the *
Required
What is your Address, City and Zip Code *
Your answer
Current Monthly Income *
Your answer
Child #1 Name, Age, Relationship
Your answer
Child #2 Name, Age, Relationship
Your answer
Child #3 Name, Age, Relationship
Your answer
Child #4 Name, Age, Relationship
Your answer
Child #5 Name, Age, Relationship
Your answer
Child #6 Name, Age, Relationship
Your answer
All Children Reside in the Home *
Required
If you are Receiving Assistance, please list such as TANF, SNAP etc. *
Your answer
Is there anything that would prevent you from attending Toy Distribution Day on December 8th? Transportation etc. *
Your answer
Additional Comments
Your answer
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