Lacombe & County Hot Lunch Porch Program Application

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* 1. I acknowledge that completing this form does not necessarily guarantee service

Yes

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* 2. I acknowledge and agree that by submitting this form I am agreeing to share my delivery information with Big Brothers Big Sisters for the sole purpose of delivering my hot lunch porch program.

Yes

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* 3. This program is for families who have been financially impacted by the COVID-19 Pandemic. Have you been financially impacted by the COVID-19 pandemic?

Yes

No

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* 4. If you are not a family who is currently involved with Big Brothers Big Sisters Lacombe and District, what school division do your children attend?

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* 5. Number of people in household, and names & ages of all kids.

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* 6. Main contact name

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* 7. Contact phone number

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* 8. Home Address

Address Line 1

Address Line 2

City/Town

Postal Code

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* 9. If our supply can meet your needs, you will be contacted accordingly.
If you have any questions or concerns, please list them below.