Your Lake County Firefighters are here to help our local families in need

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* 1. First & Last Name?
Nombre y apellido ?

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* 2. What is your street address?
¿Cuál es su dirección de la calle ?

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* 3. In what city do you live?
¿En qué ciudad vives?

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* 4. State?
Estado ?

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* 5. Zip Code?
Código postal ?

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* 6. At what email address would you like to be contacted?
¿A qué dirección de correo electrónico le gustaría ser contactado?

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* 7. Contact phone number? 
Teléfono de contacto ?

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* 8. List the children's first and last name and age you are applying for

Indique el nombre y apellido del niño y la edad que solicita

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* 9. Please review our simple guidelines for assistance to make sure you qualify.
1. You and your children must live in Lake County, Florida. Proof of residency required. (Driver license, power bill, etc)
2. You will need to bring with you a COPY of a birth certificate that we can keep for each child you need assistance with
3. Assistance is available for children ages 0 to 12 years old
4. A copy of your 2018 W2 (proof of income) will be required.
5. Applicants that have used the program 3 years or more may not qualify due to high demand for the program.
6. We will do everything we can to make your appointment work for you. However, if you do not show for your appointment and do not contact us in advance, you will no longer to qualify to shop and your position will be given to someone on the wait list. If you can not make your scheduled appointment, please contact us at least 48 hours in advance at info@lakefirefightercharity.com

Por favor revise nuestras sencillas pautas de asistencia para asegurarse de que califique.
1. Usted y sus hijos deben vivir en Lake County, Florida. Se requiere prueba de residencia. (Licencia de conducir, factura de electricidad, etc.)
2. Deberá traer una COPIA de un certificado de nacimiento que podamos conservar para cada niño con el que necesite ayuda.
3. La asistencia está disponible para niños de 0 a 12 años de edad
4. Se requerirá una copia de su W2 2018 (prueba de ingresos).
5. Los solicitantes que hayan utilizado el programa por 3 años o más pueden no calificar debido a la gran demanda del programa.
6. Haremos todo lo posible para que su cita funcione para usted. Sin embargo, si no se presenta a su cita y no se pone en contacto con nosotros con anticipación, ya no podrá calificar para comprar y su puesto se otorgará a alguien en la lista de espera. Si no puede concertar su cita programada, comuníquese con nosotros al menos con 48 horas de antelación a info@lakefirefightercharity.com

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* 10. Have you applied/received for assistance anywhere else?

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* 11. Were you referred by anyone or an organization? If so, who?

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* 12. We try to assist as many families as possible. Anyone found to abuse the system will be denied future assistance from this or any of our programs. Thank you for understanding and making it fair for everyone needing help.

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