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

Child's School

Desired Delivery Date

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?