CUMBY OPERATION BLUE SANTA ~ ASSISTANCE REQUEST FORM – City of Cumby

Today’s weather: ☀️ Clear sky 78°F/58°F (Updated 10:12 AM)

City Hall Time: 🕒 --:--

Name

First

Last

Address

Address Line 1

Address Line 2

City

State

Zip Code

/ a with

Phone

Child Name & Age

Male / Female

Male
Female

Wishlist Items / Likes / Hobbies

Clothing / Shoe Size

Describe any needs your child might have.

Does your child need a winter coat?

Yes
No

Do you need assistance with a holiday meal?

Yes
No

Diapers / Wipes - (add size and preference)

Allergies / Dislikes