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2012 Secret Santa Program Registration & Donation Form

To register and/or donate for the 2011 Secret Santa Program online please complete the form below. If you choose to register by mail, please click here to display the 2012 Secret Santa Sponsor Application.


Register On-Line

Please complete all the information to register as a Secret Santa Sponsor or to donate.


Name *
Company/Agency *
Address 1 *
Address 2
City *
State *
ZIP *
Home Phone *
Work/Other Phone *
Email *

 YES!
I want to be a Secret Santa!

Number of Boys I/we will sponsor
# Preferred Ages:

Number of Girls I/we will sponsor
# Preferred Ages:

Please select the Regional Office nearest you who’s Secret Santa Program you wish to support.
Metro-East (Belleville) Region
Carbondale Region
Mt. Vernon Region

You will be notified by a representative from the office you selected.

Thanks so much for your interest and participation.
 No

I/we do not wish to sponsor a child this year, but would like to donate to the 2011 Secret Santa Program and other children’s programs at Christian Social Services of Illinois.

I/we will donate online now.

I/we will mail payment to the Christian Social Services Region of our choosing.






Thank you so very much for your generosity!



Christian Social Services, 8601 West Main St., Belleville, IL 62223, 800-997-9702
[ Last update: Feb 01, 2012 ]