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News & Updates
Shop with a Cop 2024 – Applications Open!
Please enable JavaScript in your browser to complete this form.
Please enable JavaScript in your browser to complete this form.
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Richwood Police Department
Shop with a Cop
December 14, 2024
The Richwood Shop with a Cop program has been helping underprivileged children since 2020. We are happy to be able to assist families in need during the holiday season.
The following application is open to eligible children
who reside within the City of Richwood
. No one 13 years of age or older is eligible to participate. Priority will be given to first-time applicants. On the shopping day, your child must be present to shop.
Applications will be accepted through December 8th, 2024. Awarded applicants will be contacted by phone on December 10th,2024.
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Parent / Guardian Name
*
Email
*
Address
*
Address Line 1
Address Line 2
City
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
State
Zip Code
Have you previously applied for aid from our program?
*
Yes
No
Have you applied for aid with any other organizations?
*
Yes
No
Relationship to Child/ Children
*
Phone
Next
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Child's Name
*
First
Last
Child's Age
*
What school do they attend?
*
Male or Female?
*
Male
Female
Child's Birthdate
*
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Child's Name
First
Last
Child's Age
What school do they attend?
Male or Female?
Male
Female
Child's Birthdate
Layout (copy) (copy)
Child's Name
First
Last
Child's Age
What school do they attend?
Male or Female?
Male
Female
Child's Birthdate
Layout (copy)
Child's Name
First
Last
Child's Age
What school do they attend?
Male or Female?
Male
Female
Child's Birthdate
Layout (copy) (copy)
Child's Name
First
Last
Child's Age
What school do they attend?
Male or Female?
Male
Female
Child's Birthdate
Next
Please explain to us why your child/children should be selected to Shop with a Cop. Be as detailed as possible, as this will help us in the selection process.
*
By completing and checking yes on this application, you give the City of Richwood the right to make inquiries with other organizations about assistance you are receiving. You also affirm that information provided is accurate and understand that any false information provided could result is disqualification from selection this year and future years.
*
Yes
No
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