Holiday Giving Application

ELIGIBILITY__________Must live in Halton Hills (Acton and Georgetown)__________Maximum after tax income of total number of people living in the home: 2 people – $55,000; 3 people – $60,000; 4 people – $65,000; over 5 people – $70,000

This field is for validation purposes and should be left unchanged.

CONTACT Name(Required)

First Last

Applicant's Date of Birth(Required)

ADDRESS (must live in the Town of Halton Hills: Acton or Georgetown)(Required)

Street Address Address Line 2 City Province Postal Code

PHONE(Required)

EMAIL(Required)

NUMBER OF CHILDREN INCLUDED IN THE APPLICATION(Required)

PICKUP LOCATION(Required)

Georgetown

Acton

PREFERRED CONTACT METHOD(Required)

Phone

CHILDREN'S INFORMATION(Required)

First Name

Last Name

Date of Birth (dd/mm/yyyy)

Gender

Pajama Size CHILD (6, 8, 10, etc.)

Pajama Size YOUTH (6, 8, 10, etc.)

Pajama Size ADULT (6, 8, 10, etc.)

Sock Size

Wish Gift (please be specific – brand, size, colour)

Depending on availability, applicants will receive a grocery gift card with their holiday bag.

HOUSEHOLD INCOME (monthly, after-tax $ amounts)(Required)

O.D.S.P.

E.I.

Ontario Works

CPP Disability

Support Payments

Employment

Other (amount)

Other (details)

Total

CONSENT TO DISCLOSE INFORMATION(Required)

I hereby CONSENT for Links2Care to disclose / request my personal information and to advocate on my behalf relating to matters dealt with by staff, and release Links2Care from all liabilities and claims that may thereby arise. Information is kept strictly confidential and is collected only to determine program eligibility and ensure those most in need receive assistance. Contact our Privacy Officer for details.

Date(Required)

UPLOAD MOST RECENT PROOF OF INCOME AND RESIDENCY IN HALTON HILLS

Drop files here or

Max. file size: 20 MB, Max. files: 10.

We will contact you in mid December with pick-up details.

Holiday Giving Application

Contact us to learn more