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**

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.

Please review the program criteria to determine if you or the senior qualifies for this program. If any of the points listed below apply, the senior does not meet the eligibility requirements.

The senior is over the age of 65
The senior lives alone and has no family support / in-home care
The senior is unable to leave their home due to limited mobility

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)

Does This Senior Drive?(Required)

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

Please check all that apply

Senior is over the age of 65

Senior lives alone with family support

The senior is isolated and unable to leave their home due to physical disabilities

Senior is unable to prepare their own meals due to health issues

Senior is not receiving any other assistance or in-home care

Allergies / Dietary Restrictions(Required)

Please note: FreeHelpCK cannot accommodate allergies or specific dietary restrictions. If you wish to receive a senior meal, it will be at your own discretion. If you wish to continue and complete the application to obtain a senior meal, please proceed below.

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

Apply for Senior Christmas

Refer A Senior

Refer A Senior