Baby Bundle Bash Application

Baby Bundle Bash

Step 1 of 3

Applicant Information
Name*
First Last
Address*
Street Address City State / Province / Region ZIP / Postal Code
Phone*
Email*
Spouse's Name
First Last
Expected Due Date*
MM slash DD slash YYYY
Service Member Information
Select the option that best reflects the service member's military status.*
- Active Duty Military
- Reservist/ National Guard
- Purple Heart Recipient Post 9/11
- Combat Action Badge or Equivalent post 9/11
Branch of Service*
Rank*
LES FOR CURRENT MILITARY OR DD214 FOR PURPLE HEART/CAB OR EQUIVALENT*
Max. file size: 256 MB.
Front of Military ID, Purple Heart Certificate, CAB or Equivalent Certificate*
Max. file size: 256 MB.
Front of Dependent ID
Max. file size: 256 MB.
Current Orders (One Page VA Rating for Purple Heart Recipients) (CAB RECIPIENTS PLEASE SKIP)*
Max. file size: 256 MB.

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Application Terms/Agreement
Please read the following and type yes if you agree to the terms below.
I have filled out the application completely.*
I verify that this will be my first or second child.*
Baby Bundle Bash is a ONE-TIME assistance per family.
I have uploaded my LES and photocopy of my Military ID. (Purple Heart Recipients should upload DD214 instead of LES and a photocopy of their Purple Heart Certificate).*
I understand that the application submission does not guarantee participation in the program and that each application is reviewed on a case by case basis. If selected, I will be notified by Military Assistance Mission. Priority is given to families in the greatest need.*
Disclosure Statement
I understand that; by submitting this application I am disclosing all information voluntarily, requested information will be used for verification purposes only, and all information requested must be submitted prior to selection. Military Assistance Mission is not obligated to purchase items for my family and I may or may not be a participant at any of their events. I understand that Military Assistance Mission is a Non-Profit organization and is not obligated in any way to assist my family based on our military service status. I acknowledge that if selected, I will NOT, under any circumstances, attempt to resell or return items donated to me. If I violate this agreement, I will reimburse Military Assistance Mission the total value of the items. If selected, I understand and agree that Military Assistance Mission is providing me with health and safety supplies and/or equipment identified as the Pack-N-Play portable baby crib. I understand that Military Assistance Mission is not a manufacturer or dealer of the health and safety supplies or equipment and does not independently test or certify the supplies or equipment. Military Assistance Mission makes no warranty of any kind regarding the fitness of the equipment provided or the equipment provided or the information and instructions accompanying the supplies or equipment. I hereby grant Military Assistance Mission, permission to use the photographic/video images taken of myself and/or my dependents and that Military Assistance Mission shall have all rights, title and interests to the image(s) and the copyrights thereto and all the related rights for their entire terms, including renewal, free and clear of all encumbrances.
I have read and understand the Application Terms/Agreement and Disclosure Statement.*
Electronic Signature*
Enter your name in the field certifying that everything in this application is true and you understand the terms of the application.
Date*

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Baby Bundle Bash

Step 1 of 3

Applicant Information

Service Member Information

Expectant Child Information

Application Terms/Agreement

Disclosure Statement