Christmas Assistance Application Form

Christmas Adopt a Family Application, 2025

Fill out the form carefully for registration
Your Information
Your Name - As Nominator (Please leave blank if you wish to remain anonymous)

First NameLast Name
Who are you Nominating *

First NameLast Name
Why are you nominating them? *
Describe why you think this family / individual is in special need this holiday season
Your Email (optional for updates):

Confirmation Emailexample@example.com
Your Phone Number (Should we have any questions)
Optional
Nominees information

Please provide as much detail as possible.
Address of Nominee *

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Nominees Email:

Confirmation Emailexample@example.com
Nominees Phone Number*
Please enter a valid phone number.
1st Name (Head of Household):

First NameLast Name
Age
Gender

MaleFemaleNon-binary
What do you think they NEED this holiday season:
Please provide a suggested list of anything that this individual would really benefit from - such as Food, Winter Clothes, Household items, Toiletries etc
What do you think they WANT this holiday season:
Please provide a suggested list of any hobbies, or interests
2nd Name:

First NameLast Name
Age
Gender

MaleFemaleNon-binary
What do you think they NEED this holiday season:
Please provide a suggested list of anything that this individual would really benefit from - such as Food, Winter Clothes, Household items, Toiletries etc
What do you think they WANT this holiday season:
Please provide a suggested list of any hobbies, or interests
3rd Name:

First NameLast Name
Age
Gender

MaleFemaleNon-binary
What do you think they NEED this holiday season:
Please provide a suggested list of anything that this individual would really benefit from - such as Food, Winter Clothes, Household items, Toiletries etc
What do you think they WANT this holiday season:
Please provide a suggested list of any hobbies, or interests
4th Name:

First NameLast Name
Age
Gender

MaleFemaleNon-binary
What do you think they NEED this holiday season:
Please provide a suggested list of anything that this individual would really benefit from - such as Food, Winter Clothes, Household items, Toiletries etc
What do you think they WANT this holiday season:
Please provide a suggested list of any hobbies, or interests
Any other household members? (Pets?)
Please input here the above questions if there are more then 4 people in the household
Thank you for your input!

We are going to do our best to make everyone's Holiday Season special. Families and individuals will be chosen based on need and ressources.

Stay tuned on events coming up where we will post more specific ways you can help!
Should be Empty:

Christmas Adopt a Family Application, 2025

Your Information

Nominees information

Thank you for your input!