Secret Santa Family Application Form 2023

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Connect Thru Cancer's Secret Santa program matches CTC families with volunteer donors to help make your holiday season a little less stressful. The number of families who receive support is dependent upon the number of volunteers. If matched, you will be asked to supply a gift list of items with your children's name, gender, ages and gift requests, if it is something specific, links are helpful.

This program is meant to provide support to current CTC families that are undergoing treatment first and then other families living with a cancer diagnosis. Deadline for this application is Friday, 10/20/2023.

You will be notified ASAP, by email, if your family is matched you will be required to submit a "giftlist" by October 29, 2023 so donors can get an early start on purchases.

PLEASE NOTE: Gift lists that include XBOX systems, I-pads, or large purchases typically do not get fulfilled.

If you have any questions please do not hesitate to reach out to us at info@connectthrucancer.org

Name: *

Email: *

Cell Phone Number (communication may be via email, call or sometimes text if preferred)

Address (Please include street address, city, state & zip code)

Please let us know if you are currently undergoing cancer treatment (chemo, radiation, surgery etc.) and what hospital system. (we track the hospitals whose patients we support) If you are in survivorship please tell us where you received treatment.

Caregiver/Spouse/Other Contact for Secret Santa questions

Please list your children's names, ages (and clothing sizes if requesting clothes)

Please tell us how this "Secret Santa" assistance program would help your family?

Average Household Income

$10,000-$25,000

$25,000-$50,000

$50,000-$100,000

$100,000-$150,000

>$150,000.00

Other:

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If matched, I will provide a gift list to CTC for the donor to pick gifts from to purchase for my children. Please remember this is a gift list and we can not guarantee all items will be purchased, but we do our best! (Please be reasonable, we have very generous donors, but large, expensive items/electronics do not usually get selected to be purchased)

Yes

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All gifts will be available for pickup by the family on a specific date in December. Will you or a loved one be willing to pick up gifts for your family in the West Chester area? At this time delivery is not available.

Yes

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What is the best method of communication? *

Text

Call me

Communicate with my spouse/other via email

Communicate with my spouse/other via text

Communicate with my spouse/other via phone call

Sometimes donors like to purchase gift cards for the parents, if this were to occur please let us know where they would be most helpful for you.

Are you a current client of CTC? If no, you will have to be registered once Secret Santa is selected in order to be a recipient.

Yes

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Submit

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