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**

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, from decorations to cake baking supplies.

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.

Apply For A Birthday Box!

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)

Are You Employed?(Required)

Yes

Laid Off

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)

Register an Angel

Apply for Senior Christmas

Birthday Boxes

Apply For A Birthday Box!