Santa for Seniors 2024

Santa for Seniors
Forms must be mailed no later than Thursday, December 12 to: Santa for Seniors, 180 Orton Road, Lawrenceburg, TN, 38464, or submitted online.

**Please note – if we do not have all information, we may be unable to deliver to the intended recipient!
Check all that apply:

Pickup will be in the rear parking lot of Providence Hall, 26 Public Square, Lawrenceburg (former Platinum Fitness), from noon until 3 p.m. on Thursday, December 19.
I will pick up my package.

YesNo
Dentures?

YesNo
Adult Diapers?

YesNo
Diabetic?

YesNo
Male or Female?

MaleFemale
Applicant Name

First NameLast Name
Applicant Address
Your Street Address (MUST BE INCLUDED FOR INCLUSION!):
Age
Phone number
Clothing size, Shoe Size, Special needs.
Directions to applicant home. (THIS IS VERY IMPORTANT)
Should be Empty: