2023 Merry Market Application

Please fill out this form and click submit.

Please fill out this form to apply for receiving toys for your kids this Christmas. A C.U. volunteer will contact you about the status of your application.

Children will not be allowed at this event.

Name

*

Email

*

This address will receive a confirmation email

Phone

*

Address

*

Have you been a recipient of Merry Market program before?

*

Please select one option.

Yes I have. No, this is my first time to apply.

Full Name of the person that referred you to apply:

*

Child 1 - Name

Age

Gender

Please select one option.

Boy Girl

Child 2 - Name

Age

Gender

Please select one option.

Boy Girl

Child 3 - Name

Age

Gender

Please select one option.

Boy Girl

Child 4 - Name

Age

Gender

Please select one option.

Boy Girl

Would you like to receive a call back from a Spanish speaker? ¿Le gustaría recibir una llamada de un hablante de español?

*

Please select one option.

YES NO

Description

Please fill out this form and click submit.

Please Fix the Following

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