Donation Pick Up Request Form

Donation Pick Up Request Form
Name*

First NameLast Name
Date of Birth*

MonthDayYear
Date
Contact Number*
Please enter a valid phone number.
Email*
example@example.com
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
ID Verification: LOGF reserves the right to request a government-issued ID or local community ID for verification purposes. Providing ID is at the discretion of the organization and may be required to receive items.

Support Needs Assessment Form

All questions help us understand how to tailor support to your household’s needs. Your information is kept strictly confidential and will only be shared with authorized staff or volunteers of the Light of Guidance Foundation’s Relief Markets exclusively for the purpose of providing assistance.
Section 1

Household Overview
1- Total household size

12345
2- Number of dependents (children, elderly or others you support)

12345+
Section 2

Work & Income
3- Current work situation (Choose one)

Working Full TimeWorking Part TimeSelf EmployedCasual Seasonal WorkLooking for WorkRetiredUnable to Work (Health Related)Other
4- Approximately total monthly household income (Before tax)

Up to $500$501 - $1000$1001 - $1500$1501 - $2000$2001 - $3000More than $3000
5- Sources of Income (Check all that apply)

Salary or WagesSelf-EmploymentPensionGovernment Benefits or Assistance (AB Income Support, AISH, Disability Benefits)Disability BenefitsChild/Family SupportOther
Section 3

Expenses & Financial Pressure
6- Monthly medical or health-related expenses

$0 - $50$51 - $150$151 - $300$301 - $500More than $500
7- Optional: Is anyone in your household managing an ongoing health condition that creates financial pressure ?

Prefer not to sayNoYes
Section 4- Assets (Optional)

These questions help us understand overall financial resilience.
8- Savings

Prefer not to sayNoneUnder $500$500 - $2000More than $2000
Household assets
9- Property owned?

NoYes
10- Vehicle owned

NoYes
Section 5

Additional Context (Optional)
11- Please tell us if any of these apply (Helps us understand short-term support needs)

Recent change in employmentCare responsibilities for elderly/disabled family membersSingle-parent householdHousing InstabilityHigh debt/loan obligationPrefer not to sayOther
Section 6 - Confirmation
I confirm that the information I have provided is true and accurate to the best of my knowledge.
Disclaimer for Donnees:

By receiving items, including but not limited to food, clothing, baby supplies, home supplies, and other essential goods, from the Light of Guidance Foundation (LOGF), the recipient acknowledges and agrees to the following terms:

1- Use of Items: All items are provided on an “as-is” basis to support individuals and families in need. LOGF makes reasonable efforts to ensure the quality and safety of distributed goods, but does not guarantee the suitability, safety, or effectiveness of any item for a particular purpose.

2- No Liability: LOGF, its employees, volunteers, and representatives shall not be held liable for any injury, damage, loss, or adverse outcome arising from the use, consumption, or handling of any item received.

3- No Refunds or Returns: Recipients understand and agree that items provided are non-refundable and non-exchangeable. LOGF will not provide replacements, refunds, or compensation for any reason.

4- Assumption of Risk: By accepting items, recipients assume all risks associated with their use, including but not limited to health, safety, or property risks.

5- Voluntary Acceptance: Receiving items from LOGF is voluntary, and recipients acknowledge that acceptance constitutes agreement to this disclaimer in full.
By accepting, you confirm that you understand and accept all of the above terms.*

I agreeI do not agree
Signature

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Donation Pick Up Request Form

Section 1

Section 2

Section 3

Section 4- Assets (Optional)

Section 5