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2660 Industrial Park Rd Smithville ON L0R 2A0

Food Bank: (905) 957-5882

Thrift Store: (905) 957-5882

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Food Bank Registration

Food Bank Registration

Food Bank Registration

Our food bank is for people living in West Lincoln, if you live outside of West Lincoln please contact the food bank in your area or call 211. To register complete the form below and someone will be in touch shortly.

WLCC Food Bank Registration

Today's Date:

Client First Name*:

Client Code:

P:

Client Last Name*:

Date of Birth*:

Gender:

Phone*:

Email*:

Confirm Email*:

Income Type:

Type of Housing:

Proof of address/ID:

Address:

Emergency Contact

Name:

Tel Number:

Add Household Members

Name:

Relationship:

DOB:

Income Type:

Client Code:

ID Given:

How did you hear about us?:

Do you need assistance applying for the Ontario Energy Savings Plan to receive a deduction on hydro?

YesNo

Would you like to apply for WLCC Housing Assistance? (those living in subsidized housing are ineligible)

YesNo

Would you like to apply for our Step-Up program? (reimbursement of children's recreational activities)

YesNo

Do you need assistance with your income tax? (we offer free assistance with a registered CRA volunteer)

YesNo

Would you like a referral to free mental health counselling? (on site counsellor available)

YesNo

Would you like a Dental/Vision assitance application? (other benefits must be used first)

YesNo

Do you have a family doctor? (The Reach Van visits our office twice per month, Thursday afternoons)

YesNo

I hereby consent to the disclosure or transmittal to, or the examination by WLCC of any relevant information deemed necessary to determine my eligibility for the services from this Agency. I understand that any misinterpretation of facts on this application form may be grounds for ineligibility of servcies. I give my consent to West Lincoln Community Care to make referrals to other support agencies on my behalf.

I agree and consent to be contacted by West Lincoln Community Care.

Customer Signature:

To register in person our hours are:

Tuesday: 9:30 am – 4:00 pm

Wednesday: 2:00 pm – 6:00 pm

Thursday: 9:30 am – 4:00 pm

If you would like to make an appointment please call: 905-957-5882

To register for our other programs please email: wlcc@bellnet.ca

WLCC Boundary Map

Need assistance?

Contact our staff for help, we’re here to help with any of your concerns.

2660 Industrial Park Rd Smithville ON L0R 2A0

Food Bank: (905) 957-5882 Thrift Store: (905) 957-5882

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We would like to give a heart filled thanks to Deanna Roberts Photography for our new website pictures.
© 2024 All rights reserved by West Lincoln Community Care (WLCC).

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