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Only children ages six (6) to eleven (11) may be selected to go shopping
at the Walmart in Benson for the annual event.
Each child’s officer will receive a gift card of $110.00. $100.00 is to be spent on
Christmas shopping for his/her family and themselves.
$10.00 is set aside on the card to pay for the sales tax.
The officers will encourage the child to spend the entire amount of $100.00,
as the cards and the receipts will be retrieved at the time of cash out.
The selection of the children will be made by SWAC board members and advisory community.
Due to the large number of applications,not every child can or will be selected.
Every attempt is made to serve those most in need. All decisions are final.
You will not be contacted unless the child has been selected.
We must have a phone number where the guardian/parent can be contacted to notify selected children.
Please make sure your recommended child is not included in any other program
or assistance organization, verification will be done.
Benson Shop With A Cop day will be December 15, 2012
commencing at 6am with breakfast, shopping, gift wrapping the items
and intentions to be completed after 9am.
Children are expected to conduct themselves in a courteous and appropiate manner.
Guardians/Parents will be called to retrieve their child if unruly
or disrespectful to the officers or the reason of the event.
Donations are always welcomed – checks made out to BSWACP
and mailed to the address listed below.
An account is held at Southeastern AZ Federal CU dedicated for this program.
Thank you for helping make life long memories for the Children.
If you have any questions regarding this program, please contact Denise Celentano at 520-940-0247
bswacp@gmail.com
Applications are to be dropped off at 1040 W. 4th street (Xpress Lube) in a sealed envelope or
Mailed to:
BSWACP
PO Box 1355
Benson, AZ 85602
Please use print button on right side and fill out this form.
APPLICATION
Completed application should be completely filled out and returned to the address below.
A telephone number must accompany this form.
Eligible children are ages 6 to 11 years of age. Deadline to have application in is November 30, 2012.
Name of Child (first & last)_______________________________________________ M/F
Age________ Birth date ___________________
School ________________________________________________ Grade _______________
Physical Address ________________________________________ City _______________
Mailing Address ________________________________________ City ________________
Phone # ____________________________Parent/Guardian Name _____________________
Name _______________________________ Your relationship to this child _____________________________________
Your phone number _______________________
Primary Reason this Child is Being Referred ________________________________________________________________
Must Explain Why You Are Referring This Child (Being Detailed Helps With The Selection Process)
_____________________________________________________________________________________________________________________________
______________________________________________________________________________________________________________________________
_______________________________________________________________________________________________________________________________
________________________________________________________________________________________________________________________________
Can this application be shared with other charity groups if not chosen? Yes_______ No_________
By completion and your signature on this application, you give BSWACP the right to make inquiries with other
organizations about assistance you are receiving. ________________________________________________
Applications are to be dropped off at 1040 W. 4th street (Xpress Lube) in a sealed envelope or
Mailed to: FOR BSWACP USE ONLY
BSWACP Approved Y- date called if approved _________
PO Box 1355 Denied Y
Benson, AZ 85602
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Application
