United for a Good Cause Request for Christmas Help - Registration Form
Applicant Information
Last Name *
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First Name, Middle Initial *
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Date *
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Address *
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Apartment/Unit #
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City *
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State *
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Zip *
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Phone *
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Email Address *
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HAVE YOU RECEIVED CHRISTMAS HELP FROM ANOTHER ORGANIZATION THIS YEAR? IF YES, LIST NAME(S)
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PLEASE PROVIDE LIST OF CHILDREN BY FIRST NAME, AGE, AND GENDER: (EX: DANNY, 5, GIRL)
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IMPORTANT! PLEASE READ:
We at United for a Good Cause Inc. will do our very best to help you this Christmas and ensure that your kids receive a toy. However, we do not honor “specific requests for toys, clothes, shoes, etc."

For your kids to get their toys, you will need to bring them to our event, the 15th Annual Emerald Coast Christmas Miracle Fiesta. It is scheduled for December 15 at the Santa Rosa Mall in Mary Esther, Fl, 1pm - 7pm. You and your kids will have a GREAT TIME!

Our Fiesta is an EVERYTHING IS FREE to all that attend event with great entertainment, food, free coats from the United Way’s Coats for Kids program, activity tables, great contests for bikes, more!
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*Your Personal Information will be protected by security safeguards that are appropriate to the sensitivity level of the information. We take all reasonable precautions to protect your Personal Information from any loss or unauthorized use, access or disclosure. We will not sell, trade or exchange your Personal Information to/with any third party.
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