STOREHOUSE FAMILY FORM

Welcome to 2026 Cloverdale Christmas Hamper Program Pre-registration Form

Please fill out this form with true and correct information.

List everyone who lives in your home, including adults and children, who will receive food from the Christmas Hamper Program.

Please check your answers and make sure you complete every field.

If you qualify for the program, you will receive an invitation to a meeting. At this meeting, we will verify the information you entered on this form. You will need to provide the required documents, such as ID for each person in your household, proof of income etc.

Important: Each household can receive only one Christmas Hamper. If you are accepted into another Christmas Hamper program, your application may be declined.

Thank you for your cooperation.

Privacy

The Cloverdale Christmas Hamper Program (CCHP) collects personal information to process your application, confirm that you qualify for the program, plan our services, and improve our programs.

We will keep your information confidential and only use it for these purposes.

Providing your information is voluntary. If you have questions about how your information is collected or used, please speak with a CCHP staff member or volunteer.

Family Details

First name *

Last name *

Birthdate *

Age Category and Gender *

Email *

Confirm email *

Address line 1 *

Address line 2 (optional)

City *

Postal code *

Language *

Have you checked in to another food bank?

Choose the food bank below. Leave it on No if you have not registered with another food bank.

Do you receive disability benefits or have official disability status?

You will be asked to provide government documents that confirm your disability benefits or status

Household Members

We need to know about all the persons living permanently in your household at the same address. Please note that you will have to provide ID for each person you add.

General Information

In a few words, please explain your reason(s) for applying for Christmas hamper *

What is the combined income for all adults (19+) in your household? *

Add totals in line 15000 from your Tax Notice of Assessment for every 19+ adult in your household. You will be asked to provide this documentation.

Declaration and Authorization

By submitting this application, I confirm that the information I have provided is true and correct.***

I authorize the Cloverdale Christmas Hamper Program (CCHP) to contact other Christmas hamper programs or organizations to verify whether I or a member of my household has applied for or received a Christmas hamper from another program.

I understand that CCHP may share and request the personal information needed to complete this verification. This information will only be used to determine eligibility for the CCHP Christmas Hamper Program and to help prevent duplicate registrations.*

Do you agree? *

Yes, I agree No, I disagree