Christmas Assistance Application Form

Operation Santa Claus Application, 2025

Fill out the form carefully for registration. Operation Santa Claus (formerly Holiday Scrolls) through Mental Health America of Hendricks County will only be serving adults living with mental illness this holiday season. Please do not include any children's Wishlist's. Please limit gift card requests to (1).
Would you like to receive a holiday food box with your gifts?
How would you like to receive your gifts?

Pick up myself at the MHAHC offices in AvonFree delivery the week before Christmas (scheduling will happen later)
Head of Household*

First NameMiddle NameLast Name
Date of Birth*

MonthDayYear
MM-DD-YYYY
Gender*

MaleFemale
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Email:*

Confirmation Emailexample@example.com
Phone Number*
Please enter a valid phone number.
Number of people in your home:*
Type number
Referring Agency:*
Type agency name
Associated Staff Member Name: *
Type employee name
Associated Staff Member Email: *
Type employee name
All Household Members

Fill out information for each person living in your home wishing to receive gifts INCLUDING the head of household listed above.
First Family Member: Name*

First NameLast Name
Date of Birth*

MonthDayYear
Date
Age:*
Male, Female, Nonbinary?*
Christmas Wishes UNDER $100
Wish #1:
Type First Wish
Wish #2:
Type Second Wish
Wish #3:
Type Third Wish
Clothing Size:
Type Size
Shoe Size:
Type Size
2nd Family Member: Name

First NameLast Name
Date of Birth

MonthDayYear
Date
Age:
Gender*
Christmas Wishes UNDER $100
Wish #1:
Type First Wish
Wish #2:
Type Second Wish
Wish #3:
Type Third Wish
Clothing Size:
Type Clothing Size
Shoe Size :
Type Shoe Size
3rd Family Member: Name

First NameLast Name
Date of Birth

MonthDayYear
Date
Age:
Male, female, non-binary
Christmas Wishes UNDER $100
Wish #1:
Type First Wish
Wish #2:
Type Second Wish
Wish #3:
Type Third Wish
Clothing Size:
Type Clothing Size
Shoe Size:
Type Shoe Size
4th Family Member: Name

First NameLast Name
Date of Birth

MonthDayYear
Date
Age:
Male, Female, Non-binary
Christmas Wishes UNDER $100
Wish #1:
Type First Wish
Wish #2:
Type Second Wish
Wish #3:
Type Third Wish
Clothing Size:
Type Clothing Size
Shoe Size:
Type Shoe Size
5th Family Member: Name

First NameLast Name
Date of Birth

MonthDayYear
Date
Age:
Male, Female or Non-binary
Christmas Wishes UNDER $100
Wish #1:
Type First Wish
Wish #2:
Type Second Wish
Wish #3:
Type Third Wish
Clothing Size:
Type Clothing Size
Shoe Size:
Type Shoe Size
Monthly Income:

Must include income for everyone working in the family
Fill in all blanks. If not applicable, enter '0
Total Household Income: *
Type Amount
Have you received help from Mental Health America of Hendricks County for Christmas before??*
Have you already, or do you plan to apply for assistance from any other agencies?*
By submitting this application, you confirm that, to the best of your knowledge, all the informatin provided is accurate and verifiably true. You also give Mental Health America of Hendricks County permission to verify any of this information. Please understand that if you are being helped by another agency in the county, you might not also be helped by Mental Helath America of Hendricks County.
Should be Empty:

Operation Santa Claus Application, 2025

All Household Members

Monthly Income: