Free Application

First name

Last name

Phone

Birthday

Month

Day

Year

Address

Total of Number of People in the Household

1-2

2-4

4 or more

Are there children (under 18)

Yes

If yes, please list their ages and genders: (This helps with selecting age-appropriate items)

Clothing Needs - Please list the sizes needed for each person in the household: Example: Child 1 (Age 5): 5T shirts/pants, Size 10 shoes.

Do you have access to a kitchen with a working stove and refrigerator?

Yes

Please list specific furniture items needed: (e.g., Twin mattress, kitchen table, dresser, lamp)

Do you have a way to transport large furniture items?

Yes

Is there anything else we should know to better assist you? (e.g., Specific items for a newborn, mobility aids, or linens)

Are you currently working with a caseworker or another community organization?

Yes

I give The Lighthouse Thrift Store of Raeford permission to take and use photos of myself/my family for promotional or fundraising purposes. (You may still receive assistance if you check 'No').

Yes

Privacy Notice & Disclosure

Confidentiality Commitment The information provided in this application is used solely to determine eligibility and to coordinate the distribution of food, clothing, and furniture. Your personal details will be kept secure and will not be sold, shared, or traded with outside marketing agencies.

Data Usage By completing this form, you understand that:

Your information will only be accessed by authorized staff and volunteers of The Lighthouse Thrift Store of Raeford.
We may share anonymized, general data (such as "total number of families served") with donors or for grant reporting, but your name and specific identity will never be attached to those reports.
In certain cases, and only with your verbal or written permission, we may contact other local agencies to coordinate larger support efforts (such as furniture delivery).

Applicant Consent & Signature

Authorization I certify that the information provided in this application is true and accurate to the best of my knowledge. I understand that the items provided by The Lighthouse Thrift Store of Raeford are gifts and are not for resale. I also understand that The Lighthouse Thrift Store of Raeford is not liable for the condition or future use of donated items.

Signature

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