Meals On Wheels Registration / Schedule update

IMPORTANT INFORMATION !

Meal deliveries take place Monday, Tuesday, Wednesday and Thursday, including 4 hot meals 1 cold meals a per week.
We do not offer weekend deliveries.
Please fill out one form for each individual client.
After you fill out this order request, we will contact you to go over details and availability before the order is completed.
If you need assistance filling out this form please call  1-250-785-6328


SENIORS CARE FOUNDATION SPONSORSHIP:

By submitting this form you will also apply for Senior Care Foundation Financial Aid.  
Applicants must be 65+ in order to be considered for financial aid.
Invoices will continue to be sent to MOW client's home address until applications are approved by the Seniors Care Foundation.
MOW clients are responsible for payment until they are approved from Seniors Care.



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Are you a new or existing customer? *
Name *
Birth date
MM
/
DD
/
YYYY
65 years or older? *
Do you want information on sponsorship through Seniors Care Foundation
Clear selection
Do you identify as an Indigenous person? *
What is the delivery address?
Phone Number
Emergency Contact (Name and Phone Number)
Email address
What is the billing address?
What date do you need meals to start?
MM
/
DD
/
YYYY
How many meals a week would you like?   *
Required
Do you eat fish and/or Shellfish?  Click all that apply. *
Required
Do you have any Allergies? *
Are any of your allergies Anaphalactic? *
Any Dietary constraints?
Clear selection
Delivery Instructions (other than front door)
Choose size and number per color
Preferred contact method *
Required
Seniors Care assistance is limited to those who are eligible for SAFER or OAS supplement (GIS) or fall into a low income bracket. You are required to show a copy of your last income tax statement. All information given to the coordinator is done so in confidence and will NEVER be shared outside of these organizations: NEAT & the Seniors Care Foundation  
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