Foodbank Registration

Please note: This information is used for record keeping and statistical purposes through Link2feed, a secure cloud-based software recommended by Food Banks Canada. Providing this information helps generate statistics that ensure continued support and funding for our Food Bank. If you are uncomfortable sharing any of this information just check “Undisclosed.” As the primary client, please fill in your own details and information on those in your household for whom you will be collecting food.

Contact Details

First Name Last Name Your email Phone

Household Info

Number of Adults in Household - include yourself Number of Children in Household

Address

Street Address Address Line 2 City ProvinceAlbertaBritish ColumbiaManitobaNew BrunswickNewfoundland and LabradorNova ScotiaOntarioPrince Edward IslandQuebecSaskatchewan Postal Code Date of Birth

Primary Applicant Info

Gender—Please choose an option—MaleFemaleTransgenderOtherUndisclosed Ethnicity —Please choose an option—IndigenousWhiteBlackSouth AsianChineseFilipinoLatin AmericanS.E. AsianWest AsianKoreanJapaneseUndisclosedOther Housing —Please choose an option—Own HomePrivate RentalSocial HousingEmergency ShelterOn the streetWith family/friendsGroup home/youth shelterBand OwnedOtherUndisclosed Marital Status—Please choose an option—SingleMarriedCommon LawDivorcedSeparatedWidowedUndisclosed Primary Income Source—Please choose an option—Full time EmploymentPart-Time EmploymentEmployment InsuranceSocial AssistanceDisabilityChild Canada BenefitCPPStudent loanNo incomeUndisclosedOther Do you identify as any of the following?A person with a disabilityLiving in Canada for less than ten yearsCurrently a post-secondary studentNone of the aboveUndisclosed Any Dietary Requirements?