FCSS Senior Connection Kit

Thank you for your interest in the FCSS Senior Connection Kit Program!

PLEASE READ BEFORE CONTINUING:

You will need to fill this information out each month as there as a limited number of bags available, this program is first come, first serve.

*COUNTY RESIDENTS*
Your bag will be ready for PICK-UP the LAST Tuesday of every month between 9 a.m. and 3 p.m. at the North Side doors of the Town of Edson building.

You may pick-up for a friend. Please text 780-723-4403 before you pick-up.

Your request for a kit has been successful if you are able to fill out this form and submit-it will bring you to another page. Thank you!

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* 1. Personal Information

First Name *

Last Name *

Address *

Neighbourhood

City/Town *

Email Address

Phone Number *

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* 2. MUST ANSWER: How many seniors are living in the household that you are ordering a kit for?

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Thank you for your submission. If you have made a mistake, please call 780-517-7055 or email alicjab@edson.ca.