Silent Auction Form | Citywide Impact

A CityWide Impact Christmas Community Registration

Please complete one registration for yourself or your household. Registration is free and helps CityWide Impact prepare enough food, supplies, care packages, and Christmas gifts for our community.

Contact & Attendance :

How will you be participating in A CityWide Impact Christmas?

I will attend the event in person

I am requesting Christmas delivery

Delivery Location

Important: Christmas deliveries are reserved for seniors, individuals, or families who are unable to attend because they do not have transportation. Delivery is not intended as a convenience option.

Deliveries are limited to pre-registered residents of New Caney, Splendora, and Porter.

Please confirm why delivery is needed:

I am a senior and unable to attend in person

I do not have transportation to the event

First & Last Name

Phone

Delivery Address

City

Attendance & Christmas Dinner

Number of meals needed

How many people total will be attending?

Out of this, how many adults will be attending?

How many adults

How many children

How many children will be attending?

Approximately what time do you plan to arrive?

Does anyone included in this registration have a food allergy we should be aware of?

🍽️ Christmas Dinner & Activity Menu

Fried Turkey — cooked in peanut oil

Ham

Turkey Gravy

Green Bean Casserole

Macaroni & Cheese

Yams

Deviled Eggs

Desserts

Hot Chocolate

Popcorn

Food Allergy Notice

Our Christmas dinner will include foods that may contain common allergens.

Important: Fried turkey will be cooked in peanut oil.

Other menu items may contain or come into contact with:

milk/dairy, eggs, wheat/gluten, soy, peanuts, tree nuts, sesame, fish, shellfish, mustard, and other seasonings or ingredients.

Food will be prepared and served in a shared kitchen environment, so cross-contact is possible.

We are not able to prepare individual special meals for food allergies or dietary restrictions.

Please review this information carefully and decide whether the food being served is appropriate for you or anyone included in your registration.

I understand that CityWide Impact cannot guarantee that any food item is free from allergens or cross-contact, and I am responsible for deciding whether the food served is safe for me or anyone in my household.

Children’s Christmas Gifts 🎁

Children must be preregistered to guarantee a Christmas gift. A limited number of gifts will be available for walk-up children while supplies last.

Are you registering any children to receive a Christmas gift?

How many children are you registering to receive a Christmas gift?

Child(ren) Info

First Name(s)

First Name(s) & Age(s) on Christmas Day

What are some things this child(ren) likes?

Examples: dinosaurs, Barbie, Bluey, trucks, sports, art, gaming, Pokémon, makeup, crafts, superheroes, etc.

Favorite Color

Anything this child(ren) especially does not like?

Santa Workshop Passport 🎅

Children receiving Christmas gifts will receive a Santa Workshop Passport at check-in. They’ll visit Christmas stations, collect the required stamps, and then make their final stop at Santa’s Toy Shop to receive their gift.

Care Packages

Care packages will be available for adults and individuals who could use a little extra support this Christmas. Contents will vary based on available donations.

Would you or another adult included in this registration like to receive a care package?

How many adult care packages are requested?

What types of items would be most helpful? (Multiple Choice)

If other, please

Important Information

Christmas Gift Registration

Preregistration guarantees an age-appropriate Christmas gift for registered children. Specific toys, brands, characters, requested items, or gift values cannot be guaranteed.

I understand.

Registration Changes

Please submit only one registration for yourself or your household. If you need to make a change after registering, please contact CityWide Impact instead of submitting another registration.

I understand.

Walk-Up Availability

Gifts for children who are not preregistered and care packages are available while supplies last.

I understand.

Is there anything else you would like CityWide Impact to know?

I understand that meal delivery is reserved for seniors who are unable to attend in person and individuals or families who do not have transportation to the event. Delivery is not offered as a convenience option.

Unfortunately this is out of our delivery zone.