Apply – Celebrate Safe

If you would like to apply for a free or subsidized birthday package for your child’s special day, please fill out the form below.

First Name

Last Name

Child's First Name

Child's Last Name

Email Address

Phone Number

Home Address

Child's School

Child's Grade

Teacher's Name

Desired Delivery Date

How many kits are needed for your child's class?

Monthly Household Income

Household Size

Primary Income Source

Rent or Mortgage Payment Amount

Are you currently receiving any goverment assistance?

If yes, what kind of government assistance do you receive?

Please upload a copy of your two most recent pay stubs (If Applicable).

Please upload a copy of your government assistance award letter (If Applicable)