Ramadhan Niyaz Signup

Ramadhan - Niyaz Sign up

The aim of the Ramadhan Daily Iftaar initiative is to provide Iftaar Niyaz to those that will benefit from it the most given the current circumstances. Delivery will take place every evening between 5:00 pm and 8:00 pm. Please only fill one form per family.
First Name *
Last Name *
Phone Number *
Email *
Number of Portions *

1 2
Address *
Apt/Unit #
Apartment / unit number
Delivery Instructions / Additional Notes
Does anyone in your household fall under any of the following categories?

Select all that apply.
Under the age of 65 with an underlying serious health condition? *

Yes No
Aged 65 years or older? *

Yes No
A person who is pregnant? *

Yes No
A frontline healthcare worker? *

Yes No
A person whose employment status has been adversely affected by the COVID-19 pandemic *

Yes No
Terms of Agreement

Please review and agree to the terms below.
I hereby waive and release any rights, actions or claims against ISIJ of Toronto for any liabilities and damages, including any food borne illnesses arising out of or in connection with the iftar delivery. I understand that my data is being collected strictly for the purposes of iftar distribution. *

I agree to the above terms.
I have reviewed my submission and confirm my contact information and address details are correct. *

I confirm that all my form details are accurante
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Ramadhan - Niyaz Sign up