Register an Angel

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

Refer A Senior

Please review the program criteria below to determine whether the senior you would like to refer meets the eligibility requirements.

  • Senior is over the age of 65
  • Senior lives alone and is receiving no family support / in-home care
  • Senior has the means to leave their home
  • Senior is unable to prepare their own meals due to health issues
  • Senior cannot afford to purchase meals

If the senior meets the eligibility requirements listed above, please complete the referral form below. A FreeHelpCK representative will contact you within 48 hours to review the referral. Our team will review your referral with care and help ensure this senior receives the support they need.

**PLEASE NOTE: ANY NEW APPLICATIONS FOR SENIORS WILL NOT BE ADDED UNTIL AUGUST 10TH, 2026**

Refer A Senior

Senior's Name(Required)
Senior's Address(Required)
Help Us Get To Know This Senior's Situation(Required)
Please check all that apply
Allergies / Dietary Restrictions(Required)
Your Name(Required)
Please let us know why you believe this senior requires this service.
Privacy Statement(Required)