Christmas Basket 2023 Application
Hello and Merry Christmas!  

Please fill out this form if you would like to apply to participate in the Safe Haven Christmas Project as a basket recipient.  Incomplete forms will NOT be accepted for intake.
Please keep in mind that these baskets are for women and children who have escaped, or are currently trying to escape, situations of abuse and domestic violence within the last year.  In order to protect the integrity of our program, please be aware that the following steps will be required:
1. Application submission (this form)
2. Intake form submission (first year only).  This form will be sent via link in text, once the team has received your application.  The process WILL NOT move forward without your intake. Please ensure that your phone number is on this application form.
3.  Intake Appointment/Review Appointment (all years).  Following the receipt of both Google forms, you will receive another text with a link to schedule an intake appointment, and instructions to TEXT to confirm the appointment.  At this time, our team will let you know what to bring to your appointment.
4.  Program Orientation.  Participation is required, based on the outcome of the intake/review appointment.  Location, date and time is TBD.
5. Details regarding basket pick-up/delivery will be determined shortly.

We look forward to talking with each of you, and celebrating together at our annual Christmas Party and basket pick-up!
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Email *
Your phone number
Your full name, and children's names
Please copy/paste the following list into each of the questions below for EACH PERSON receiving baskets, and answer accordingly.
Age:
Pant size:
Underwear size:
Diaper size:
Shirt size:
Bra size:
Shoe size:
Favorite color:
Favorite Show/Movie:
Favorite Food/Restaurant:
Favorite Treat/Candy:
Hobbies:
Large gift wish:
Favorite self care:
Any formula specifics:
Any dietary or other allergy restrictions:
Dislikes, or anything this person will not use/like:
Christmas wish list:
Needs:
Bed size:
Favorite scent:
Favorite stores (up to 5):
Favorite Animal:
Special needs (please be as specific as you feel comfortable):

What is one EXPERIENCE gift your family would enjoy?
If your family has a game system, which one?
Where are you located appx (to ensure any gift cards are local)?
Do you have a Christmas Tree?
Clear selection
Would your children prefer:  Bike, scooter, roller blades, or skate board?  Please list accordingly
Do you have stockings?
Clear selection
Please tell us anything else you feel may be helpful to know in providing Christmas for your family.
Submit
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