CUMBY OPERATION BLUE SANTA

CUMBY OPERATION BLUE SANTA ~ ASSISTANCE REQUEST FORM

PLEASE SUBMIT ONE FORM PER CHILD YOU ARE REQUESTING ASSISTANCE FOR. NOTE-YOU MUST BE A CITY OF CUMBY UTILITY CUSTOMER OR BE A CITY OF CUMBY RESIDENT. ADDRESSES WILL BE VERIFIED. APPLICATION DEADLINE, NOVEMBER 21ST, 2025

Name

First

Last

Address

Address Line 1

Address Line 2

City

State

Zip Code

Phone

Child Name & Age

Male / Female

Male
Female

Wishlist Items / Likes / Hobbies

Clothing / Shoe Size

Describe any needs your child might have.

Dislikes / Shoe

Does your child need a winter coat?

Do you need assistance with a holiday meal?

Diapers / Wipes - (add size and preference)

Allergies / Dislikes

CUMBY OPERATION BLUE SANTA ~ ASSISTANCE REQUEST FORM

Cumby, TX

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