Intake Form

Service Area*
Not sure which to pick? Read about our services on our website lifespin.org
The following fields are all hidden by default and show conditionally based on the service area.
Children & Youth Programs:
LIFE*SPIN is partnering with Ashley Homestore to provide our families with Beds this Christmas. Families who qualify will recieve a twin bed frame, mattress, pillow, coverlet, and sheet set. Ashley Homestore will ship the bed directly to the family in need and have it set up for them.

This program is for children ages 3 to 16 who are currently without a bed. The family needs to be surviving on low-income or transitioning out of a shelter. You can learn more about the program at: https://ashleyhomestore.ca/pages/hope-to-dream

If you qualify, LIFE*SPIN will send your family's information to Ashely Homestore. From there Ashley Homestore will be contacting families to set up delivery. Delivery will be expected in December.

Please fill out the form below with the nessary informaiton. We will contact you to let you know the status of your application.

Please note that this program is only available to current LIFE*SPIN clients.

If you are in need of multiple beds you will have to fill out a form for each child.
By selecting this box you are giving consent for us to share your information with Ashley Homestore, who will be administering the Hope to Dream program.*

I consent to having my information sent to Ashley Homestore
Nutrition Program*
How did you learn about LIFE*SPIN's Program?
Name of the Child Receiving the Bed *
Age of Child Receiving the Bed*
Advocacy: I require help to complete the application forms for:*

Social Assistance (Ontario Works, Internal Reviews, Special Diet Allowance)Discretionary Assistance (funerals, pregnancy, utilities, diabetic supplies, mattresses , etc)Seniors Pensions (Canada Pension Plan, Guaranteed Income Supplement, Old Age Security, Seniors Dental Program, Seniors Co-Payment Program)Disability Benefits (Special Services at Home [children only], Canada Pension Plan-Disability, Ontario Disability Support Program, Assistance for Children with Severe Disabilities, Disability Tax Credit)Health Benefits (Ontario Drug Benefit, Vision & Dental Benefits)Housing Supports Forms (Housing Stability Bank, Connected for Success, Subsidized Housing, Ontario Renovates, Ontario Electricity Support Program)Death Benefits (Canada Pension Plan - Spouse & Child Survivor Benefits, Canada Pension Plan - Death Benefit, Discretionary Funeral Assistance)
Advocacy Short
Event/Workshop Info:
Tax Years
Please list the tax year(s) you would like help filing.
Pocket Sized Farms 2026

The Garden Kits for Pocket Sized Farms will be delivered the week of May 18th.

Pocket Sized Farms will be running FREE outings 4 days a week runs from June 29 to August 21 for children ages 7 to 12 years-old.

Parent or a guardian 16 years or older is required to join the outings.

To join us please complete the information below and submit.
Little Gardener's Name(s):
Please provide the names of all the children participating in your family.
To help customize your kits, please tell us how will you be gardening this year?

In containersIn the groundBoth in containers and in the ground
Which level of gardening experience do you have?

Beginner GardenerCasual GardenerExperienced Gardener
Contact Information
Please provide the participant's parent/guardian information in the section below. We will be delivering gardening kits, so please ensure that the contact information and address sections are correct.
Prefill

fromEmail
Full Name*

First NameLast Name
Please input the names of all the individuals in your family who will need to shop at the Free Store.
Date of Birth*

DayMonthYear
Email is {email36}*
Email*

Confirmation Emailexample@example.com
Phone Number*
Please enter a valid phone number. Do not include a preceding 1, even if your number is long distance.
Select if you have an alternate contact you would like to include:

Yes
Name and phone number (including extension) of alternate contact:
Address*

Street Address

Unit Number

CityProvince

Postal Code
City*
City
Province*
Province
Postal Code*
Postal Code
Buzzer Number
If you live in an apartment building, enter the buzzer number
Please double check this address information, including the unit number. If the address is incorrect you may not receive the service you have requested.
Household Information

The mission of LIFE*SPIN is to provide information and support for individuals who are surviving on low incomes
Household Information

SingleCouple
Your partner's first & last name
Languages spoken in the home*

EnglishArabicSpanishOther
Do you need an interpreter?

YesNo
Please note that we currently only have an interpreter for Arabic, Greek, and Spanish. If you speak any other language you will have to provide your own intperpreter.
Sources of household income (please check all that apply)*

Canada Child Benefit (CCB)Ontario Disability Support Program (ODSP)Life Stabilization - Ontario Works (OW)Old Age Security (OAS)Guaranteed Income Supplement (GIS) - FederalGuaranteed Annual Income System (GAINS) - ProvincialRetirement Income Fund (RIF)Canada Pension Plan (CPP) RetirementWork Pension (WP)Canada Pension Plan Disability (CPP-D)Assistance for Children with Severe Disabilities (ACSD)Student Loan (S-Loan)Child Support (C-Sup)Spousal Support (S-Sup)Employed (EMP)Self- Employed - ie Uber, Rental Income, Contract, etc (S-EMP)Employment Insurance (El)Workers Compensation Benefits (WSIB)Other
Income Sources
How many adults (18+) live in your household?

Please enter the number of people who live in your household, by age category:*

	Male	Female	Non-Binary
Age 0-6
Age 7-12
Age 13-18
Age 19-25
Age 26-64
Age 65+

Children Ages 0-12
Tables Field
Youth Ages 13 - 25
Tables Field
Adults Ages 26 - 64
Seniors 65+
Tables Field
Children 7-12
Tables Field
Girls Ages 13-18
Tables Field
Children 18 and under
Tables Field
How many of these adults are 60+?
Is anyone in your household pregnant?

YesNo
If yes, date the baby is due.

MonthDayYear
How many children live with you (less than 18 years old)?
Child Information*
Child Information
Please provide any additional information you would like us to know about you child, such as dietary restrictions and accommodations.
Today

MonthDayYear
Would you like to receive our newsletter and be notified of new programs that might interest you?*

Notify by emailDo not notify me
You can view our Privacy Policy at: https://www.lifespin.org/what-we-do
Should be Empty:

The following fields are all hidden by default and show conditionally based on the service area.

Pocket Sized Farms 2026

Contact Information

Please provide the participant's parent/guardian information in the section below. We will be delivering gardening kits, so please ensure that the contact information and address sections are correct.

Household Information