Please fill out this form if you, someone you know, or your organization are in need of assistance. Santa Tim will do his best to make a difference. Please note that we are only able to provide services and support to residents of Sonoma County, CA. Once you submit the form, Santa Tim or his elves will be in contact ASAP.

Your Name

First Name

Last Name

Your Email Address

Your Phone #:

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Are you requesting assistance for yourself or someone else? (Please explain your relation to the other person.)

Details of the Request

Are there any details you would like to provide us about the recipient's story or background?

Address of Person Receiving Assistance

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Recipient's Name

Please fill out if you are requesting on behalf of someone else.

First Name

Last Name

Recipient's Phone Number

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