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Blue Santa Application

  1. Has Blue Santa Helped you before?

  2. Are you receiving assistance from another source?*

  3. All applicants will be screened and other sources will be checked for duplications. Blue Santa will only provide Christmas for the children that are living in your household. If we are unable to contact you, you will be removed from the list.

  4. Childs name, age, and gender

  5. Leave This Blank:

  6. This field is not part of the form submission.