Application Form | North Hastings Holiday Hamper Program

2024 NH Holiday Hamper Application

Primary Applicant Name *

Address *

First Name/Age of all Children (under 16) *

Phone Number *

Names of all members in the household (16 years or older) *

If you have a child under 12 months that is using formula, please let us know the brand in the Additional Comments Section

Referral Source - How did you hear about the program? *

Protein *

Turkey
Ham
Chicken

While we endeavour to ensure that everyone receives their preferred choice of protein, the North Hastings Holiday Hamper Program reserves the right to substitute with another protein if necessary.

Allergies *

Additional Comments:

Please note; the information collected on this application is strictly for use within the agencies that provide support to those in the community of Bancroft, and will not be shared with anyone not bound by a confidentiality agreement within these agencies.