The Salvation Army 2017 Christmas Hamper Application

Page 1 - Family info






Please enter your postal code

One of our staff will be following up your application with a follow up phone call. If we can't reach you by phone, we will contract you via e-mail.

Page 2 - Adult Info


Your First Name

Your Last Name

Your Health Card Number

First name of other adult living at the residence.

Last name of other adult living at the residence.

Enter Health Card # if there is more then one adult living at your residence

Page 3 - Child Info


Please enter your child's first and last name, their age, birthday's gender and then health card number.

Please enter your child's first and last name, their age, birthday's, gender and then health card number.

Please enter your child's first and last name, their age, birthday's, gender and then health card number.

Please enter your child's first and last name, their age, birthday's, gender and then health card number.

Please enter your child's first and last name, their age, birthday's, gender and then health card number.

Please enter your child's first and last name, their age, Birthday's, gender and then health card number.

Page 4 - Income Info



Income from Wages

PTA/TEA/Training Allowance (if applicable)

Income from student Loan (if applicable)

Income from Social services (if applicable)

Income from Employment Insurance (if applicable)

Total income from Child Tax Credit (if applicable)

Page 5 - Income Info / Expences


Income from Pension (if applicable)

Rent/Mortgage

Utilities

Telephone (Basic Only)

Babysitting

Groceries/Food

Page 6 - Final



Groceries/Food


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