HOLIDAY GIVING APPLICATION

Holiday Giving Application - Deadline November 10, 2023

ELIGIBILITY__________Must live in Halton Hills (Acton, Georgetown and outskirts)__________Maximum after-tax household income: $28,000 (1-2 people in home); $39,000 (2-4 people in home); $48,000 (5-6 people in home); $52,000 (7+ people in home)

CONTACT Name(Required)

First Last

ADDRESS(Required)

Street address and unit CITY: Must live in Halton Hills (Acton/Georgetown and outskirts)

Phone

CHILDREN'S INFORMATION

First Name

Last Name

Date of Birth (dd/mm/yyyy)

Gender (M or F)

Gift Card (W or GT): 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)

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.

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.

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