JavaScript isn't enabled in your browser, so this file can't be opened. Enable and reload.
Application NEW Dec Children with Deceased Parent(s)
This Application is ONLY for Children Whose Parents are Deceased
Sign in to Google
to save your progress.
Learn more
* Indicates required question
Email
*
Your email
Only For Children Whose Parent (s) is Deceased 2021 Bear Program
*
Option 1
Parent/Legal Guardian Name
*
Your answer
Correct phone number (cell & home please)
*
Your answer
FULL Address (Street Address, City and Zipcode)
*
Your answer
Who is filling out this form?
*
Choose
I am the Legal Guardian/ Parent
Social Worker/ Case Worker
Friend/ Family Member
Pastor
If you are NOT the Legal Guardian Write your Name and Phone Number (we will void the application without it). Tell us why you are completing the application for them,
Your answer
Do you have Documentation (Death Certificate, Obituary) of the parent's death? Send a copy of death certificate and an obituary (newspaper or funeral home website link) to
info@augustasangels.org
*
Yes
No
Maybe
Which Parent is Deceased?
*
Choose
Mother
Father
What is the parent's legal name?
*
Your answer
What did the child call the parent?
*
Your answer
Name, Address include City & State of funeral Home that took care funeral Services . Phone number if you have it. This is to verify the information. We will call if we need more info.
*
Your answer
Date the Parent Died
*
MM
/
DD
/
YYYY
Parent's Cause of Death
*
Choose
COVID-19
Cancer
Domestic Violence
Homicide
Suicide
Natural Causes (old Age)
Auto Accident
Other Ilness
Other
Did you or anyone in your household ever test positive for COVID at anytime? This will not stop you from getting Christmas Gifts as we will be social distancing and we wont have any contact during distribution.
*
Yes
No
More than one person
Entire house hold
Did you have a family member outside your household die from COVID? (0ther than the deceased Parent )
*
Yes
No
More than one
What are your family's other needs? Are you working? Do you need any other assistance?
*
Your answer
Did you lose anything in Laura
*
No
Yes
Everything
Did you lose anything in Delta
*
Yes
No
Everything
First Child's Name (first and last)
*
Your answer
First Child's Birthdate
MM
/
DD
/
YYYY
First Child's Gender
*
Female
Male
First Child's Age
*
Choose
under 1
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
First Child's Shirt Size
*
Your answer
First Child's Pants Size
*
Your answer
First Child's Designated Size
*
Child's
Child's Plus
Jr
Jr Plus
Adult
Adult Plus
Required
First Child's Shoe Size
*
Your answer
First Child About: Child's Favorite Color, Movie, Tv Show and Character
*
Your answer
First Child Suggested Gift (Toy) List 3 Toys
Your answer
Second Child's Name (first and last)
Your answer
Second Child's Gender
Female
Male
Clear selection
Second Child's Birthdate
MM
/
DD
/
YYYY
Second Child's Age
Choose
under 1
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
Second Child's Shirt Size
Your answer
Second Child's Pants Size
Your answer
Second Child's Designated Size
Choose
Child's
Child's Plus
Jr
Jr Plus
Adult
Adult Plus
Second Child's Shoe Size
Your answer
Second Child About Tell us about the child. Favorite Color, Favorite Movie, Favorite TV Show
Your answer
Second Child Toy Suggestion List 3 Toys
Your answer
Third Child's Name (first and last)
Your answer
Third Child's Gender
Choose
Female
Male
Third Child's Birthdate
MM
/
DD
/
YYYY
Third Child's Age
Choose
under 1
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
Third Child's Shirt Size
Your answer
Third Child's Pants Size
Your answer
Third Child's Designated Size
Choose
Child's
Child's Plus
Jr
Jr Plus
Adult
Adult Plus
Third Child's shoe Size
Your answer
Third Child Suggested Gift (Toy) List 3 Toys
Your answer
Third Child About: What is the child's Favorite Color, Character, TV Show and Movie
Your answer
Fourth Child's Name (first and last)
Your answer
Fourth Child's Gender
Female
Male
Clear selection
Fourth Child's Birthday
MM
/
DD
/
YYYY
Fourth Child's Age
Choose
under 1
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
Fourth Child's Shirt Size
Your answer
Fourth Child's Pants Size
Your answer
Fourth Child's Designated Size
Choose
Child's
Child's Plus
Jr
Jr Plus
Adult
Adult Plus
Fourth Child's Shoe Size
Your answer
Fourth Child Suggested Gift (Toy) List 3 Toys the child would like.
Your answer
Fourth Tell us about the child. Favorite Color, Favorite Movie, Favorite TV Show
Your answer
Submit
Clear form
Never submit passwords through Google Forms.
This form was created inside of Area Angel Tree Coordinators.
Report Abuse
Forms
