Emergency Application

Emergency Repair Application

Emergency Repair Application

Use this form if you are in need of emergency home repairs.

Contact Us

Elderly
Disabled
Veteran
Yes
No
Yes
No
Yes
No

Please submit a proof of income form (with SS# blacked out) either by uploading a scanned image or by faxing a copy to 817-645-0961, or mailing to C I A, P.O. Box 983, Cleburne, TX 76033

Please submit below allowing permission for our House Selection Chairman to contact you and discuss your project.

By signing this application, you release Christmas in Action for all or any liabilities for accidents that may occur on your

property. You also grant Christmas in Action permission to use photos of your project in brochures and news articles.

Recipients are asked to welcome volunteers with courtesy and extend their appreciation of their services.

I agree to above statement and all information given is true.If you are ready to submit your information, please click the Agree button below to allow us permission to contact you and discuss scheduling the project.

By checking, I agree to share my form responses.
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