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Applicant Info
Full Name
Full Address (Street, Apartment/Unit # if applicable, City, State, Zip Code)
Phone Number
Email
Date Of Birth
Gender
Male
Female
ID Type (Driver's License, Health Card, Passport, Social Insurance Number, Permanent Residence, Other)
ID Number
Expenses (If these do not apply to you, please state that instead of typing the amount)
Rent/Mortgage
Personal Expenses
Utilities
Phone
Child Support
Transit ($110/person)
Other (Specify)
Dietary Restrictions
Diabetic
Halal
Non-Halal
Vegetarian
Other
Please Specify Other Dietary Restrictions
Eligible for Zakat?
Yes
No
Dependents
Please Enter Their Names, Relation to You, and Their Birthday
Privacy Waiver
I
hereby
consent to
SACREDHAND CANADA
collecting and using my personal information including but not limited to name, address, telephone number, age, family situation, medical information, and other information which can identify me and my personal, financial, and health situation. I understand that SACREDHAND CANADA requires this information and other information in order to open and maintain an active client file for me and my family, stats, purposes, and to provide services to me and my family as a client of SACREDHAND CANADA or to refer me or my family to other appropriate services from which I may benefit.
SACREDHAND CANADA will not use this information for anything outside of their services to me and my family. SACREDHAND CANADA will not disclose this information to any other parties other than affiliated agencies or service partners that would reasonably be expected to have access to this information as required by law. All family members must agree with the above.
I also understand that although SACREDHAND CANADA will use all reasonable efforts to check the expiry date of the products and they follow the expiration regulations of Health Canada. I hereby waive SACREDHAND CANADA, its staff and volunteers of all legal liability if I do eat an expired product and suffer harm.
I agree to the terms & conditions
Submit Application
Thanks for applying to volunteer with us! We'll get back to you soon.
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