The Holiday Toy Drive
Sign Up – Program Application

Toy Drive – Toy Request

Families living in Pike County and residing in the Delaware Valley school districts should contact Toys For Kids Tri-State. Toy request application dates through Toys For Kids Tri-State may differ from The ZIPPERJUNCTION Project’s application period.

If you are a Parent or Guardian and are interested in receiving toys for your child/children please complete the following application AFTER reading the guidelines shown below. Based on donations received, we may only be able to help a limited number of children. Therefore, applications will be considered in the order they are received and video calls will be scheduled via a Zoom conference call to determine eligibility. Completing this form is not a guarantee you will receive a gift for your child/children.

If eligible, you will be notified via email of the approval and will be given a distribution day and time appointment. Be sure to check your email and spam folder.

Once you submit the form, you will receive an email to confirm your email address. You will not receive an email if you did not completely fill out the form. A successful completion is when you click SUBMIT at the end of the page and see the response: Thank you for completing the Toy Request Form. A Toy Request Form confirmation email will be sent to you via the email address you provided on the form. If you don’t receive it within 24 hours, please check your junk or spam folder. If you still haven’t received it, please contact us.

We will be determining your eligibility for this program and will notify you of the decision by the end of November. If approved, an appointment will be assigned to you for toy pickup, and at that time more information will be provided. Be sure to check your email and spam folder.

On the day of distribution, you will be escorted to the toy selection area and will have no more than 30 minutes to make selections. The Parent/Guardian must be present and show appropriate documentation.

If you have any questions, please contact us via email at TheHolidayToyDrive@ZipperJunction.org.

If you need assistance completing this form, please call (570) 390-7066.

Please note: If your application is approved, you will be required to come to a location in Hawley, PA 18428 to pick up toys.

Guidelines:
- You can only sign your child/children up for one program in Wayne and Pike County,
- You MUST be the parent or legal guardian of the child/children,
- The child/children MUST reside in Wayne or Pike Counties, PA,
- A child can only be signed up for THIS program one time, per year,
- The parent/guardian applicant and each child must be actively receiving SNAP benefits through December 31, 2026.
- A child MUST be age newborn to 18 years old with a birthdate of 12/14/2007 or later,
- You MUST provide valid contact information including YOUR OWN unique valid email address, if you do not have one, please create one. Shared email addresses will not be accepted.
- The child’s name and date of birth MUST match EXACTLY what is listed on their Birth Certificate and Compass Benefits,
Applications will be accepted through 11:59 PM, October 31, 2026.

An asterisk * next to a field name means that it is required.
Have you registered and been accepted to receive toys / gifts from another program within Wayne or Pike Counties this holiday season?*
Thank you for your interest in The Holiday Toy Drive.

Unfortunately, you are only able to register for one program in Wayne / Pike County per holiday season.
Which county do you reside in?*
Thank you for your interest in The Holiday Toy Drive.

At this time, we are only able to service residents of Wayne and Pike counties. We hope to be able to provide services to additional areas in the future.
Do you AND the child/children reside in Wayne or Pike Counties, PA?*
Currently, we are only able to service residents of Wayne and Pike counties. We hope to be able to provide services to additional areas in the future.
Are you the parent or legal guardian of the child/children?*
You MUST be the parent or legal guardian of the child/children to apply for this program.
Do you currently receive SNAP assistance through the Wayne or Pike Counties, PA Assistance Office?*
Currently, this is the only means we can use to verify eligibility.
Do the child/children receive SNAP assistance through the Wayne or Pike Counties, PA Assistance Office?*
Currently, this is the only means we can use to verify eligibility.
Note: Your child/children MUST be age newborn to 18 years old WITH a birthdate of 12/14/2007 or later

An asterisk * next to a field name means that it is required.

Parent/Guardian First Name*
Parent/Guardian Last Name*

Physical Address
Address Line 1*
Address Line 2
Address Line 3
City*
State*
ZIP Code*
Borough or Township

Mailing Address
Is your mailing address the same as your physical address?*

No

Yes
Address Line 1*
Address Line 2
Address Line 3
City*
State*
ZIP Code*
Borough or Township

Contact Preference
Best phone # to reach you*
You must enter a working phone number with a voice mail capable of accepting a message
Best email to reach you*
You must provide valid contact information including YOUR OWN unique valid email address, if you do not have one, please create one. Shared email addresses will not be accepted. BEFORE CONTINUING: Please add The ZIPPER JUNCTION Project™ email TheHolidayToyDrive@ZipperJunction.org to your contacts including phone number 570-390-7066 under the contact name The Holiday Toy Drive to ensure you receive all correspondence and so all calls can be answered at time of call.
Enter Email Confirm Email

Best times to reach you*
Morning 9:00 AM – 12:00 PM
Afternoon 12:00 PM – 5:00 PM
Evening 5:00 PM – 9:00 PM
Other (if not available between hours listed above please include time frame and comments below)
Other time to reach you*
Child Information*
NOTE: Regarding the SCHOOL section, please make the appropriate selection as it relates to each child.

Add ALL children on one submission form.

Please note: Based on your “Yes” selections you will be required to show:
● A current COMPASS benefits confirmation letter valid at minimum through December 31, 2026, or COMPASS Website with Parent/Legal Guardian name and your child’s/children’s name and benefits listed. You MUST check you are able to log onto the COMPASS Website PRIOR to your Zoom meeting, and/or obtain a Current COMPASS benefit confirmation letter, with your current address, from the Wayne or Pike County Assistance Office PRIOR to your ZOOM Meeting.
● No Exceptions

Click the + to add another child
First Name Last Name Date of Birth Sex as appears on birth certificate School SNAP

A child MUST be age newborn to 18 years old with a birth date of December 14, 2007, or later. Anyone not meeting the criteria will not be approved.

School District Abbreviations:
DVSD – Delaware Valley School District
ESASD – East Stroudsburg Area School District
FCRSD – Forest City Regional School District
NPSD – North Pocono School District
WASD – Wallenpaupack Area School District
WHSD – Wayne Highlands School District
WWSD – Western Wayne School District

Required Documentation
For the Parent/Guardian:

Identification – A Valid Picture ID with name and signature (i.e. driver’s license)

Proof of physical residence – A Current Utility Bill showing proof of address (such as Electric, Phone, Water Bill etc.) or your COMPASS benefits confirmation letter with your child’s/children’s benefits listed (preferred)

If Applicable:
If not the parent – a court order stating custody (for each child)

For each Child:

Birth Certificate

Documentation of assistance noted above:
SNAP – Must show COMPASS benefits confirmation letter, COMPASS APP, and/or COMPASS website. (Determined during verification appointment)

By checking this box, I understand this information is required to be presented on the day of eligibility verification via Zoom*
I understand
By checking this box, I understand that by completing this Program Application it is not a guarantee of eligibility for this years’ program*
I understand
By checking this box, I do hereby release The ZIPPER JUNCTION™ Project from any liability as they seek to assist me.*
I agree
By checking this box, I allow The ZIPPER JUNCTION™ Project to share my name with other organizations and Churches to verify I am not receiving help from other entities.*
I agree

By entering my name below and submitting this form, I certify that all information provided on this form is true and correct and will be used to determine eligibility.
Full Name*
To let us know you are a real person, please enter the characters indicated in the box below
To let us know you are a real person, please enter the characters indicated in the box below
Note: As long as you do not have errors on the form indicating There was a problem with your submission. Errors have been highlighted below, after clicking the submit button below to submit the form, an email will be sent to the address you entered above.

If you haven’t already done so, please check you are able to log onto the COMPASS Website and/or obtain a Current COMPASS benefit confirmation letter, with your current address, from the Wayne or Pike County Assistance Office. This MUST be done PRIOR to your ZOOM Meeting.

If you have not already done so, please add our email TheHolidayToyDrive@ZipperJunction.org to your contacts including phone number 570-390-7066 under the name The Holiday Toy Drive. This will ensure you receive all correspondence and so calls appear as The Holiday Toy Drive on caller ID at time of call. In order to process your application, your email, phone and voice mail MUST be in working order.

When you receive the email, click the link to confirm your email address, your Program Application will not be considered until you do so. The link will take you to a page that shows your email address and a button that says “click here to confirm.” Please click to confirm your email address.

If you don’t receive it within 24 hours, please check your junk or spam folder. If you still haven’t received it, please contact us at TheHolidayToyDrive@zipperjunction.org or (570) 390-7066.

Have you entered ALL children you are requesting toys for on this form? If yes, click submit. If no, add additional children in the appropriate section above, then click submit. You may enter as many children that you are the parent or legal guardian of as long as each child meets the criteria.
Request ID

IsGmail

The Holiday Toy DriveSign Up – Program Application

Toy Drive – Toy Request

Physical Address

Mailing Address

Contact Preference

Required Documentation

The Holiday Toy Drive
Sign Up – Program Application