WESN Service Application Form

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Please provide your contact information

Services required (Check all that apply)

Better at Home services are for seniors, 55+ experiencing one or more of the following:

- Low to moderate income

- Risk of frailty

- Barriers to accessing programs (ie: health or mobility challenges)

- Member of an equity deserving group (2SLGBTQIA+, BIPOC, newcomers to Canada, socially isolated, etc.)

Light Housekeeping (Waitlist only - wait times 1 year minimum)

Grocery shopping and delivery

Check-in calls or emails

Friendly visiting

Minor home repairs (Note: Tasks that are non-trades only)

Transportation to/from medical appointments

Tech @ Home (For on-site tech appointments, call 604-669-5051)

Social Prescribing

Housing navigation (not Better at Home)

Peer Support (not Better at Home)

Social Meals

Required

First name *

Last Name *

Address (Please include your buzzer number if applicable) *

Birth Date *

YYYY

Gender *

Female

Male

Non-binary

Transgender

Prefer not to answer

Other:

Phone Number *

Please indicate if it's a cell or home phone *

Cell Phone

Home Phone

Other:

Required

Alternate phone number

Please indicate if it's a cell or home phone

Cell Phone

Home Phone

Other:

Email address

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