OnLine Application

Sign up to receive a carefully curated holiday package for your child(ren) ages 4-13!

The Packages Include:

Warm Clothing, Hat, Gloves, Socks and Underwear
Art Supplies & Books
Toys, Games & Sweets
Dental Kit
Special Gifts: Girls aged 4-9 will receive a beautifully dressed doll, and boys aged 4-5 will receive a cuddly teddy bear!

Eligibility: The program is available to children born between January 1, 2011 and December 31, 2020 who reside in Detroit, Hamtramck, Harper Woods, Highland Park, River Rouge, Redford & Ecorse. Only applications from these cities for children in that age group will be processed.

Package Pick up: You will receive instructions for package pick up in early December via text, email and post. Pickups are typically the second and third week of December.

Confidentiality: We are committed to protecting the privacy of the families we serve. Your information will be held in strict confidence and will not be shared with any other organization or agency.

Who is filling out this form?*

MotherFatherGuardian

Your Email*

Confirmation Email

Mother's Full Name

First NameLast Name

Father's Full Name

First NameLast Name

Guardian's Full Name

First NameLast Name

Your Address (this is where your confirmation letter will be sent)*

Street Address

Address Continued

CityState

ZIP

Your Cell Phone*

Area CodePhone Number

Please provide the child(ren)'s full name, Gender, Birthdate and MI Health Number. If they do not have a MI Health Number, please enter 12345.

You can apply for up to eight (8) children on this application. When finished, be sure to click the Submit button at the bottom.

1st Child's Full Name*

First NameLast Name

Gender*

BoyGirl

Birth Date*

MonthDayYear

MI Health No.*

Another Child?*

YesNo

2nd Child's Full Name

First NameLast Name

Gender

BoyGirl

Birth Date

MonthDayYear

MI Health No.

Another Child?

YesNo

3rd Child's Full Name

First NameLast Name

Gender

BoyGirl

Birth Date

MonthDayYear

MI Health No.

Another Child?

YesNo

4th Child's Full Name

First NameLast Name

Gender

BoyGirl

Birth Date

MonthDayYear

MI Health No.

Another Child?

YesNo

5th Child's Full Name

First NameLast Name

Gender

BoyGirl

Birth Date

MonthDayYear

MI Health No.

Another Child?

YesNo

6th Child's Full Name

First NameLast Name

Gender

BoyGirl

Birth Date

MonthDayYear

MI Health No.

Another Child?

YesNo

7th Child's Full Name

First NameLast Name

Gender

BoyGirl

Birth Date

MonthDayYear

MI Health No.

Another Child?

YesNo

8th Child's Full Name

First NameLast Name

Gender

BoyGirl

Birth Date

MonthDayYear

MI Health No.

How did you hear about this program?*

If other, please describe*

Terms & Conditions: I understand that by submitting this form, I consent to receiving updates and information about this program via voice, email, mail or text (text & data charges may apply). I also understand that at the time of pick up, I will be required to show identification for both the parent or guardian and the child(ren) enrolled in the program*

I accept the terms and conditions

Detroit Goodfellow's Holiday Package Application