Welcome Home Kit Application
Client's Name
*
First Name
Last Name
Application Date
*
-
Month
-
Day
Year
Date
Email
*
example@example.com
Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Address
*
Street Address
Street Address Line 2
State / Province
Please briefly describe your situation
*
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Do you identify with any of the following?
Single
Family
Unstable housing/homeless
Indigenous
LGBTQ2S+
Disabled
Mental Health Concerns
Substance use/recovery
Food insecurities
Transition Housing/Facility
Youth aging out of care
Trauma/Violence/Abuse
Items Needed
What household items are you missing?
Kitchen Items
Kettle
Slow Cooker
Toaster
Coffee Maker
Cooking Utensils & Saucepans
Cutlery Set
4 Piece set of dishes with mugs
Other
Cleaning Supplies
Dish Clothes & Tea towels
Dish Detergent
Laundry Detergent
Bathroom cleaner/plunger
Lightbulbs
Paper towel
Toilet Paper
Bedding & Linen
Double bed sheet set
2 pillows and cases
2 bath towels & face cloths
Laundry Basket
Bedside Lamp
If you have any special requests for your Welcome Home Kit, please share them here. Requests will be reviewed on a case-by-case basis and fulfilled when possible, subject to approval and availability.
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