Adopt An Elder Sponsorship Form

Circle of Care St. Louis - Adopt an Elder Sponsorship Registration
Name

First NameLast Name
Organization/Group Name
Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Email
example@example.com
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Preferred Contact Method
Sponsorship Details
How many older adults are you willing to support?
Preferred support situation
How did you hear about the Adopt an Elder program?
Would you like to include a financial donation with your sponsorship?
Gift Preparation and Delivery
Circle of Care St. Louis privately identifies eligible older adults and determines gift needs internally. Sponsors will receive only general approved shopping and gift guidance that does not identify or describe any recipient.

Please purchase approved gifts and nonperishable pantry items according to the general instructions provided, and deliver all items unwrapped by appointment by December 11, 2026 to 431 Chez Paree Drive, Hazelwood, MO 63042.

Circle of Care St. Louis alone selects, packages, wraps, and distributes all items. There is no direct sponsor-recipient contact.
Preferred Delivery Drop Off Date

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
Preferred Delivery Time
Acknowledgment and Signature
By submitting this form, I understand that Circle of Care St. Louis will privately determine eligible older adults and gift needs, and that I will receive only general approved shopping and gift guidance or donation instructions.

I agree to purchase approved gifts and nonperishable pantry items, deliver them unwrapped by appointment by December 11, 2026 to 431 Chez Paree Drive, Hazelwood, MO 63042, and follow all program instructions.

I understand there is no direct sponsor-recipient contact and that Circle of Care St. Louis alone selects, packages, wraps, and distributes all items.
Signature
Date

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
Thank you for your generosity. Circle of Care St. Louis will confirm your registration and provide sponsor instructions using your registration name and confirmation number only.

If you have questions, please contact us at 314-873-3501.
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Circle of Care St. Louis - Adopt an Elder Sponsorship Registration

Sponsorship Details

Gift Preparation and Delivery

Acknowledgment and Signature