Fairfield County 2-1-1 – Charity Newsies Food Application 2026

Accepting Applications starting October 2, 2026 until the program is full
Pick Up/Delivery: Saturday, December 19th
This application is for holiday FOOD only. It is not an application for Christmas toys or gifts.
Please bring a photo ID for the person applying.
Applications will be accepted on a first come, first serve basis.

Photo ID Verified

Date

Staff use only

Parent / Guardian Information

Full Name

Relationship to Children

Street Address

City

Primary Phone

Alternate Phone

Other Adults in Household

Household Members (Children under 18 living in the home)

Total People in Household

Pick Up or Delivery?

Child 1 Name

Age

Child 2 Name

Age

Child 3 Name

Age

Child 4 Name

Age

Child 5 Name

Age

Child 6 Name

Age

Additional Information

Anything else we should know?

Signature

I certify that the information on this application is true and that the children listed live in my household. I understand this application is for holiday food only.

Parent / Guardian Name (Please Print)

Date

Parent / Guardian Signature

For Staff Use Only

Approved / Denied

# of Children

Pick-Up / Delivery

Notes

This section is completed by program staff only.

Finished filling out your food application?