Christmas Food Box Sign Up

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If you'd like to sign up for our Christmas Food Box, please complete this form. To qualify, you will need to be within the income eligibility as well as live in the Waynesboro Area School District and Greencastle Area School District in Pennsylvania. Income self-declaration is included in this form.

Christmas Food Box will be picked up curbside at Human Services from 9 a.m. - 12 p.m. curbside on December 16, 2022.

To sign up for Christmas Gifts for children and teens or to be adopted you will need to show proof of income from the past 30 days for all adults in your household. ALL Gifts sign up will be in person this year at WCHS during our operating hours starting Oct 11th. Gift sign up ends Dec 2nd.

Email *

Last Name *

First Name *

Do you live in the Waynesboro Area or Greencastle Area school district? *

Yes

Street Address *

City, State, Zip code *

Phone number *

Number of people in your household *

Self-declaration of Need - Total Household Income (based on 185% of Poverty)

Looking at the chart below, is your total household income equal to or less than the amount listed for your family size?

If so, please sign below.

If not, you are not eligible for this program.

For a household of 1, your monthly income must be $2095 or less

For a household of 2, your monthly income must be $2823 or less

For a household of 3, your monthly income must be $3551 or less

For a household of 4, your monthly income must be $4278 or less

For a household of 5, your monthly income must be $5006 or less

For a household of 6, your monthly income must be $5734 or less

For a household of 7, your monthly income must be $6431 or less

For a household of 8, your monthly income must be $7189 or less

For each additional family, add $728 monthly

I understand the household income limitations and hereby certify that my household size and income make me eligible for participation in this program.

I understand that making a false statement may result in my not being eligible for Christmas food box program next year.

Please type your name below as your electronic signature.

Send me a copy of my responses.

Submit

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