How to Register

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:

Food Bank Hours

Tuesday: 9:30 am – 4:00 pm

Wednesday: 2:00 pm – 6:00 pm

Thursday: 9:30 am – 4:00 pm

Any questions?

Email: wlcc@bellnet.ca

WLCC Boundary Map

Need assistance?

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

Contact Us!