2000 Feet, Inc. Application for Shoes4KIDS

How to Apply:
  • Read the Eligibility Requirements (Click Here).

  • Complete this form online only or apply in person. Do not make copies of this application.

  • Read the agreement (at the bottom of the application) and check the “Agreement Acceptance”
    box before submitting the form.  
For FAQ's : (Frequently Asked Questions) - Click Here.

Check the reason for your request AND FAX OR EMAIL PROOF OF YOUR REQUEST. If sending a fax, send to 636.447.6362. Your application is not complete without proof of your request.

Currently experiencing a temporary hardship or crisis
Currently receiving Food Stamps or TANF
Currently receiving Government Assistance for Health/Medical Care
Child is currently disabled and require special, orthopedic shoes or footwear

Parent or Guardian Information
First Name:
Last Name:
Street Address:
City:
State: ZIP Code:
Home Phone:
Cell Phone:
Work Phone:
E-Mail Address:
You will be notified via email first, then by phone.
Your Ethnicity/Race:

This information is collected to make sure everyone is treated fairly.
Your answer is voluntary, and it will not affect your eligibility or benefit amount.

List all information for each child age 5 to 15 years old (Maximum is 3 kids per household)
Child's First Name
Child's Last Name
Age
Shoe
Size
Date of Birth
(mm/dd/yyyy)
Gender
Last 4 Numbers on
Social Security Card
1.
M or F
2.
M or F
3.
M or F

Check which event you plan to attend (You may only attend one event per calendar year)
Event Details, Click Here>>>

I am applying for an urgent or critical need.
Please note that benefits are based on availabiltiy of funds. We will notify you via email.
  Our 2010 events will be posted at a later date. At this time we are only accepting Hardhip/Crisis cases.  

Questions or Comments


Agreement and Signature

By submitting this application, I waive and release any and all rights and claims for 2000 Feet, Inc., and its personnel, committees, volunteers and sponsors for any injury suffered by my child(ren) or myself at said event. If photos, videos or recordings are taken of my child(ren) or me, I give permission for 2000 Feet, Inc. and its affiliates to use any photographs, videotapes or other recordings of my child(ren) to be used in promotional pamphlets, website, newsletter, etc.

I understand that if any information or document provided proves to be false or misleading, I and my child(ren) will be disqualified and cannot participate in any 2000 Feet, Inc., programs.
I AGREE to the above terms and conditions. (Checking this box serves as your digital signature.)




2000 Feet, Inc. | PO Box 50114 | St. Louis, MO 63105 | 636.447.6362 | shoes4KIDS@2000FEET.org