Test basket request 2021 Please enter your physical address only. Addresses will be verified and deliveries will only be made to individuals residing at the listed address. Household size is inclusive of individuals living in the home on a full time basis.Recipient First Name (required) Recipient Last Name (required) Requester's Email (required) if no email, please enter jinglebellsbaskets@gmail.com Address (No PO Boxes) Recipient House Number or Building Number (required) Recipient Street Name (required) Recipient Apartment Number Recipient City, Zipcode (required) Alexandria, 56308Barrett, 56311Belle River, 56319Brandon, 56315Carlos, 56319Clotho, 56347Elbow Lake, 56531Evansville, 56326Farwell, 56327Garfield, 56332Glenwood, 56334Hoffman, 56339Holmes City, 56341Kensington, 56343Leaf Valley, 56332Long Prairie, 56347Lowry, 56349Millerville, 56315Miltona, 56354Nelson, 56355Osakis, 56360Parkers Prairie, 56361Rose City, 56446Sauk Centre, 56378Starbuck, 56381Urbank, 56361Villard, 56385West Union, 56389Westport, 56385 **Please note, our delivery area has changed. Our volunteers will only deliver to areas listed. Volunteers work diligently to fulfill requests, but please be aware basket requests are not guaranteed. Recipient's Phone (required) Requester's Phone (required) Directions to Recipient's Home (required) Adults in Recipient Household (Full Time) (required) 123456Children in Recipient Household (Full Time) (required) 0123456789Child 1 First Name Last Name Date of Birth (mm/dd/yyyy) Gender MaleFemale Child's Interests. Examples: barbie, books, trucks, etc... 10 words maximum. No Gift WantedIf requesting a bike for your wish list - specify the size needed. Click for Sizing Chart No Bike Requested12"14"16"18"20"24"26"Child 2 First Name Last Name Date of Birth (mm/dd/yyyy) Gender MaleFemale Child's Interests. Examples: barbie, books, trucks, etc... 10 words maximum. No Gift WantedIf requesting a bike for your wish list - specify the size needed. Click for Sizing Chart No Bike Requested12"14"16"18"20"24"26"Child 3 First Name Last Name Date of Birth (mm/dd/yyyy) Gender MaleFemale Child's Interests. Examples: barbie, books, trucks, etc... 10 words maximum. No Gift WantedIf requesting a bike for your wish list - specify the size needed. Click for Sizing Chart No Bike Requested12"14"16"18"20"24"26"Child 4 First Name Last Name Date of Birth (mm/dd/yyyy) Gender MaleFemale Child's Interests. Examples: barbie, books, trucks, etc... 10 words maximum. No Gift WantedIf requesting a bike for your wish list - specify the size needed. Click for Sizing Chart No Bike Requested12"14"16"18"20"24"26"Child 5 First Name Last Name Date of Birth (mm/dd/yyyy) Gender MaleFemale Child's Interests. Examples: barbie, books, trucks, etc... 10 words maximum. No Gift WantedIf requesting a bike for your wish list - specify the size needed. Click for Sizing Chart No Bike Requested12"14"16"18"20"24"26"Child 6 First Name Last Name Date of Birth (mm/dd/yyyy) Gender MaleFemale Child's Interests. Examples: barbie, books, trucks, etc... 10 words maximum. No Gift WantedIf requesting a bike for your wish list - specify the size needed. Click for Sizing Chart No Bike Requested12"14"16"18"20"24"26"Child 7 First Name Last Name Date of Birth (mm/dd/yyyy) Gender MaleFemale Child's Interests. Examples: barbie, books, trucks, etc... 10 words maximum. No Gift WantedIf requesting a bike for your wish list - specify the size needed. Click for Sizing Chart No Bike Requested12"14"16"18"20"24"26"Child 8 First Name Last Name Date of Birth (mm/dd/yyyy) Gender MaleFemale Child's Interests. Examples: barbie, books, trucks, etc... 10 words maximum. No Gift WantedIf requesting a bike for your wish list - specify the size needed. Click for Sizing Chart No Bike Requested12"14"16"18"20"24"26"Child 9 First Name Last Name Date of Birth (mm/dd/yyyy) Gender MaleFemale Child's Interests. Examples: barbie, books, trucks, etc... 10 words maximum. No Gift WantedIf requesting a bike for your wish list - specify the size needed. Click for Sizing Chart No Bike Requested12"14"16"18"20"24"26"Child 10 First Name Last Name Date of Birth (mm/dd/yyyy) Gender MaleFemale Child's Interests. Examples: barbie, books, trucks, etc... 10 words maximum. No Gift WantedIf requesting a bike for your wish list - specify the size needed. Click for Sizing Chart No Bike Requested12"14"16"18"20"24"26"How did you hear about the Jingle Bells Telethon? RadioFriendsTVFlyerI acknowledge that all individuals listed on this form reside in the home full time and that I am not ordering food or toys for others outside of the home of the recipientPlease note- Intentional inaccurate and/or false information will result in decline of basket request