I certify that the information is true and correct. I give permission to Help for Others to check and share my personal confidential case records as necessary to verify the above information. I understand that if I give false, misleading or incomplete information I may be disqualified from the program. If I apply to more than one place my application will be removed from the Holiday Coalition.

Bring photo ID and proof of Loudoun County residency to the store. In addition bring one of the following for each child applied for report card, letter from school, immunization record or other proof of child’s identity. If an adult is disabled you must bring proof of disability.

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