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

Birthday Boxes

Every child deserves to feel special on their birthday, but for families facing financial challenges, celebrating can be difficult. Our Birthday Boxes provide children in need with a box full of party essentials, including decorations, cake baking supplies, and more.

This program supports parents so that children can enjoy and celebrate important milestones, even when resources are limited. If your family could use a Birthday Box, please apply using the form below.

**Please note that we require 10 days notice to accommodate any birthday box request **

Apply For A Birthday Box!

I Acknowledge(Required)

I acknowledge that the Birthday Box Program is available to recipients under the age of 15

Parent Legal Name(Required)

First Last

Address(Required)

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Phone(Required)

Email(Required)

What Is Your Primary Source Of Income?(Required)

Working Full-Time

Working Part-Time

Unemployed / Laid Off

Government Benefits

Child's Name(Required)

First Last

Child's Date Of Birth -mm/dd/yyyy(Required)

Boy or Girl?(Required)

What Age Is He/She Turning?(Required)

Please Provide A Brief Description Of Your Child's Interests(Required)

Please Upload A Photo Of Your Child's Health Card.(Required)

Max. file size: 64 MB.

Privacy Statement(Required)

By completing this form, I acknowledge and consent to the collection, use, and storage of my personal information and my child’s personal information by FreeHelpCK. All information will be kept strictly confidential and used only to support program eligibility and delivery.

Register an Angel

Apply for Senior Christmas

Birthday Boxes

Apply For A Birthday Box!