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Apply for Senior Christmas

Nothing embodies the spirit of giving around the holidays more than FreeHelpCK’s Adopt a Senior program. For the 7th consecutive year, our organization will focus on 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 or apply for yourself for our 2025 Adopt a Senior program.

BEFORE COMPLETING THE FORM BELOW, PLEASE MAKE SURE YOU MEET THE ELIGIBILITY CRITERIA FOR THIS PROGRAM.

You are over the age of 65

You live alone and have no family

You have limited mobility and are unable to get out

Your Name(Required)

Your Phone

Your Email(Required)

Relationship to Senior(Required)

Senior's Name(Required)

Senior's Age(Required)

Senior's Date of Birth

Senior's Phone(Required)

Senior's Email

Senior's Address(Required)

Street Address City State / Province / Region ZIP / Postal Code Country

Please Pick 3 Gifts You Would Like to Receive(Required)

Christmas Candys / Cookies

Lap Blanket

Personalized Tea Towel

Mug Set

Puzzle Books

What Is Something You Need That Is Not On The List?(Required)

**PLEASE PUT A SIZE IF IT'S AN ITEM OF CLOTHING OR FOOTWEAR**

Contact Information

For more information, inquiries, or to get involved, please contact us with the form here. We are eager to hear from you, and look forward to partnering together to make a difference in our community!

FreeHelpCK

Charity Business #
764444402RR0001

Register an Angel

Apply for Senior Christmas

Contact Information

FreeHelpCK

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