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Chelsea’s Christmas Application

2026 Christmas Gifts (for children 17 and under)  ·  Fairfield County 2-1-1  ·  Lancaster, Ohio

Applications accepted October 13 – December 4, 2026
For households in the Amanda Clearcreek School or Fire District ONLY.
Please bring photo ID, social security cards, or birth certificates for everyone in the household, and proof of address.
ID & Address Verified
Date
Staff use only
Household
Adults in Household (18 & older — list Head of Household first)

Adult 1 — Head of Household

Adult 2

Adult 3

Adult 4

Children in Household (17 years old or younger)

Please state if the child’s size is a Child, Junior, Women or Men size. There is no guarantee wishes will be granted.

Child 1

Child 2

Child 3

Child 4

Child 5

Child 6

Child 7

Child 8

Monthly Income & Expenses
Monthly Income
Monthly Expenses
Additional Information
Signature

By my signature, I give Fairfield County 2-1-1 permission to release information necessary to process this application for the receipt of holiday benefits as stated above.

Signature
For Staff Use Only
Approved / Denied
# of Children
Pick-Up Date
Notes

This section is completed by program staff only.

Finished filling out your application?

(EMAIL ONLY - OFFICE IS MOVING) Print it (or save as PDF) and e-mail it to info@fairfieldcounty211.org, or fax it to (740) 689-9827. Include copies of your required documents.

Chelsea’s Christmas Application 2026