Christmas Assistance

Please complete the form below to request your Christmas Hamper or Gifts. Please note - for Blue Mountains residents ONLY

Pick Up Times

Please pick up at your selected time.

Pick Up Location

2 Station Street, Katoomba NSW 2730
02 47821555

Please complete

Christmas Assistance Application

First Name

Family Name

Phone

Address

Address Line 1

Address Line 2

City

Post Code

Please tick from the list below what kind of assistance you would like this Christmas?

I would like to apply for a Christmas food hamper

I would like to receive help providing gifts to my children this Christmas

Are you receiving assistance from another organisation this Christmas?

Yes

Please provide information on the kind of support you are receiving in the box below

Please select a collection time slot from the options below for your Christmas hamper. Hampers will be collected on Thursday 14th December. Please note, we are unable to deliver hampers to you. Any hampers not collected will not be kept over the Christmas period and will be forfeited.

Thursday 14th December:

10am - 11am

1pm - 2pm

2pm - 3pm

I am unavailable to collect my hamper on Thursday 14th December and will require an alternative collection date.

Household Details

Number of adults living in your household:

Do you have children?

Yes

Children Details

We'd love to match an appropriate toy to your child so that they receive something for Christmas they will love. Please give us more details about your child to help us select the right gift for them. Whilst we will do our best, please remember that we rely on donations for our Christmas gifts and hampers.

Children

First Name	Family Name	Age	Gender	Interest 1	Interest 2

Please note: Centrelink Income Statement or Medicare card must be sighted upon submission of this application form.

Documentation Upload: Please use this button to upload PDF, scans or photos of your statement or Medicare card. Max 3MB file size.

Choose File

I confirm I am currently residing in the Blue Mountains and that the information entered in this form is true and correct.

Signature

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Christmas Assistance

Pick Up Times

Pick Up Location

Please complete

Household Details

Children Details

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