Nominate a Senior

Nothing embodies the spirit of giving around the holidays more than FreeHelpCK’s Adopt a Senior program. For the 6th consecutive year, our organization will be focusing our attention this upcoming holiday season by accompanying and delivering a festive holiday dinner, and gifts to seniors who are alone on Christmas Eve.

Please complete all the information in the following form to nominate a senior, for the our 2024 Adopt a Senior program.

Refer A Senior

Know someone who could benefit from this program? Please complete the form below, and a FreeHelpCK representative will reach out within 48 hours. We’ll review your referral with care and help ensure this senior receives the support they need.

Refer A Senior

Senior's Name(Required)

First Last

Senior's Phone(Required)

Senior's Date of Birth (Month/Year)(Required)

Senior's Address(Required)

Street Address Apartment Number City Province Postal Code

Relationship To Senior(Required)

Dietary Restrictions/Allergies?(Required)

Does This Senior Drive?(Required)

Help Us Get To Know This Senior's Situation(Required)

Please check all that apply

He/She is over the age of 65

He/She lives alone with limited support

He/She is on a fixed or limited income

He/She struggles with limited mobility

He/She is experiencing food insecurity and would benefit from this program

Your Name(Required)

First Last

Your Phone(Required)

Your Email(Required)

Why Are You Referring This Senior?(Required)

Please let us know why you believe this senior requires this service.

Register an Angel

Nominate a Senior

Refer A Senior

Refer A Senior