2025 CILSJ HOLIDAY SANTA EVENT W/ SANTA FOR CHILDREN W/ DISABILITIES

CENTER FOR INDEPENDENT LIVING OF SOUTH JERSEY INC.

2025 HOLIDAY TOY SHOP WITH SANTA FOR CHILDREN WITH DISABILITIES LOCATED IN CAMDEN AND GLOUCESTER COUNTIES, MINUS 08101, 08102, 08103, 08104, AND 08105.
CENTER FOR INDEPENDENT LIVING OF SOUTH JERSEY INC.

Center for Independent Living of South Jersey, Inc. (CILSJ), will be holding our 5th Annual Holiday Santa Event on FRIDAY, December 12th 2025 from 4-6pm. This will be an outdoor experience for children to receive a gift, as well as greet Santa Claus. This is a registration only event and children must be present for gifts and photos. Please be advised that CILSJ is a non-profit organization and we only serve persons with disabilities and their families, who reside in Camden and Gloucester Counties, excluding 08101, 08102, 08103, 08104, AND 08105. ***Please DO NOT register if you are unable to pick up during the event***REGISTRATION IS ONLINE ONLY!!
Do you or a family member in the home have a disability?*

YESNO
Do you reside in Camden or Gloucester County?*

Camden CountyGloucester County
Do you reside in Camden City, NJ? This includes area codes 08101, 08102, 08103, 08104, and 08105.*

YESNO
Let's start with parent/guardian's first and last name.*

First NameLast Name
Please enter parent/guardian's date of birth.*

MonthDayYear
Date
Please upload a photo id of the parent/guardian filling out this application, for identification purposes.*

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Email*
example@example.com
Phone Number*
Please enter a valid phone number.
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Please upload proof of medical diagnosis for parent or child, such as a photo of first page of official documentation, IEP, 504 Plan, award letter, doctors info etc. to keep on file for proof.*

Cancelof
In which category does your/his/her disability belong?*

Visual (vision)Auditory (hearing)PhysicalMental (anxiety, depression, PTSD, etc.)Intellectual/CognitiveTraumatic Brain Injury (TBI)
How many children are you registering? Children must live in the home and adult must be legal guardian.*

12345678
Please give name, age, gender, favorite color, and THREE REASONABLE LIKES of each child. The children will be choosing from the Toy Shop this year. There will be no prewrapped gifts.*
The undersigned certifies that the information/answers provided are complete and true. You further agree to the following:

• I/My child has a disability.

• I understand that CILSJ is a 501(c)(3) non-profit organization. CILSJ can only serves residents within Camden or Gloucester Counties, NOT Camden City, NJ as there is a separate office in the city for resident use.

• There is no cost involved.

• You will receive email confirmation by Friday, December 13th with a reminder.

• I understand that CILSJ is a 501(c)(3) non-profit organization.
- PLEASE BE ADVISED THERE WILL BE NO PICKUPS OUTSIDE OF THE EVENT DATE AND TIME : FRIDAY, DECEMBER 12TH 4-6PM. REGISTERED CHILDREN MUST BE PRESENT FOR THIS EVENT.
I understand that Center for Independent Living of South Jersey, Inc. is a 501(c)(3) non-profit organization, serving persons with disabilities and their families in both Camden and Gloucester Counties, not including zip codes 08101, 08102, 08103, 08104, and 08105. Please type your full name and today's date to certify that you understand the previous information and that all statements are true.
Signature*

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CENTER FOR INDEPENDENT LIVING OF SOUTH JERSEY INC.

CENTER FOR INDEPENDENT LIVING OF SOUTH JERSEY INC.