Holiday Giving Application

ELIGIBILITY__________Must live in Halton Hills (Acton, Georgetown and outskirts)__________Maximum after tax income of total number of people living in the home: 1 person – $35,000; 2 people – $45,000; 3 people – $47,500; 4 people – $50,000; 5 people – $52,500; over 5 people – $52,500 + $2,500 for each additional person

CONTACT Name(Required)

First Last

ADDRESS (must live in the Town of Halton Hills: Acton, Georgetown and outskirts)(Required)

Street Address Address Line 2 City Province Postal Code

Phone

CHILDREN'S INFORMATION(Required)

First Name

Last Name

Date of Birth (dd/mm/yyyy)

Gender

Gift Card: Walmart or Giant Tiger

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

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

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

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

ODSP

E.I.

O.W.

CPP Disability

Support Payments

Employment

Other (amount)

Other (details)

Total

CONSENT TO DISCLOSE INFORMATION(Required)

Personal information is collected solely for determining program eligibility to ensure support for those most in need. Information is kept strictly confidential. Contact Links2Care’s Privacy Officer at 905-873-6502 or [email protected] for more details.

I authorize Links2Care to release/request information and advocate on my behalf and release Links2Care from all claims and liabilities arising out of the release/request of this information.

Date(Required)

UPLOAD MOST RECENT NOTICE OF ASSESSMENT

Drop files here or

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

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

Phone

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

Holiday Giving Application

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