Santa Cop & Heroes Program
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Online
​Application

Fill out the form below or print out
​the application and Return via e-mail

Criteria for Eligibility:
Must be 60+ years old AND alone* On Christmas (two eligible persons in same household may qualify).
*“Alone” means no one will be visiting you and you will not be visiting others (there are exceptions for Christmas Friendship Dinner or attending worship services).
The form should only be completed if you are eligible for the program. Any violation of the eligibility criteria may result in ineligibility for any future Santa Cop Christmas programs.
We do ask that you apply as soon as possible so our elves have time to do their shopping...er...building for your gifts. We want to have your information two weeks before Black Friday (Nov. 13).
If you feel  more comfortable filling out a paper version of this form, click the green button below and then e-mail a scan of your completed form to: [email protected]
Download Print Version

    Online Application


    Fill in only if differs from Physical Address.

    Select one.
    Let us know when you would like us to deliver your gifts on Christmas.

    If you are receiving assistance in filling out this form, pleas list their details here:

    Wish List Suggestions

    Please be as specific as possible.
    e.g. Men's XL Winter Coat
    e.g. Women's 6 snowboots
    Specify Type if needed
    e.g. Blu-ray, DVD, VHS, CD, MP3, etc.
    Is there anything else that would make you smile or be more comfortable?
    Specify Type and number owned.
Submit
©2017-2020. Santa Cop. All Rights Reserved.
In partnership with BETTERTOGETHERAK
 Managed by Consulting Solutions Group & Essqué Productions
  • Home
  • About Us
    • Our Mission
    • Photo Gallery >
      • Barn Dances
      • Gift Delivery
      • Governors Award
      • 4-Wheeling with Seniors
      • 2015 Christmas
      • 2016 Christmas
      • 2017 Christmas
  • Senior Application
  • Get Involved
    • Be a Santa, Be a Friend
    • Better Together Opportunities
  • Upcoming Events
  • Sponsors
  • Contact Us