Sharing Christmas - Store Application 2025

2025 Sharing Christmas Store Application

The Sharing Christmas Store is located at the Empower Campus Community Room. The Sharing Christmas Store dates are Saturday, December 6th 9am-6pm, Monday-Wednesday, December 8th-10th 9am-3pm.

**Please fill out one application only. All duplicates will be deleted. If changes need to be made, please contact The Community Outreach**

If you have questions about completing this application, contact

The Community Outreach @ 605-331-3935.
Referring Agency*
Church/School Name*
Contact Information
First Name*
Last Name*
Street Address*
Apt. / Unit #
City*
Date of Birth*

MonthDayYear
Date
State*
Zip Code*
5 Digits
Phone Number*
Email*

Confirmation EmailPlease verify your email
Will you be the one shopping in the store?*

YesNo, someone else will shop in my place
Adult Store Shopper *

First NameLast Name
Total # of People in Household*
Include ALL Children and Adults living in the house/ apartment
Total # of Children*
17 and Younger
List ALL Household members who are 18 and older*
Household Helper

	$
After Tax Wages
TANF
Social Security
Disability Income
Child Support
SNAP
Other Income

	$
Rent
Food
Car Payments
Car Insurance
Medical Items
Child Support
Loan Repayments
Phone
Other Expenses

Important Information:
- Each family can only apply to receive assistance from ONE major holiday giving program. The Sharing Christmas program works with other Sioux Falls programs to avoid duplication to ensure as many families as possible are helped.
- Sharing Christmas only serves families that live within 15 miles of 1915 E 8th Street, Sioux Falls, SD 57103.
Acceptance Notification:

NOTE: You will receive an email by November 30th letting you know if you were accepted or not. If accepted, the letter will inform you on how and when to shop in the Sharing Christmas Store.

Shopping in the store is available by invitation only and you will need to provide the invitation letter and state issued ID.

If you do not receive an email by Dec. 4th, please contact The Community Outreach at 605-331-3935.
MEDIA RELEASE

I, the undersigned, hereby voluntarily grant to The Community Outreach, without compensation, permission to use my name, photograph(s), video and audio tapes, art work, creative writing and/or information for the purposes of illustrating agency programs and services in agency and capital campaign material including print, television, radio, video and internet/web.
For a Minor

I, the undersigned, hereby voluntarily grant to The Community Outreach, without
compensation, permission to use
Print name of minor(s)* 's
name, photograph(s), video and audio tapes, art work, creative writing and/or information for the purposes of illustrating The Community Outreach programs and services in agency and capital campaign material including print, television, radio, video and internet/web.
Media Release Agreement*

I acknowledge and agree to the terms of the Media Release for both myself and the minor listed above.
By submitting this form, I hereby authorize the Sharing Christmas Program to release the necessary information to those agencies and donors that wish to provide assistance to my family. A Release of Information (ROI) for the Helpline Center Network of Care (HCNC) is required. This form will serve as acceptable documentation for this program. I can confirm the information above is correct and hereby release the Sharing Christmas Program and partnering organizations, families, and volunteers from any and all liability. I understand this is not a guarantee of assistance.
Signature*

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Print Full Name*
Date*

MonthDayYear
Application Helper

Store
Should be Empty:

Contact Information