AGRHS Christmas Basket- 2025 Application Form
Application form to be completed by Friday, November 26. 
Printed applications are available at the Main Office or at Student Services.
Email *
(LAST NAME), (First name) of the parent/guardian *
Full address of the parent/guardian who will pick up the basket *
Use format: (Civic address),  (Town),  (Postal code)
Phone number (to reach you easily) *
Number of adult(s) in your household *
Number of children (within the family) in the home for Christmas *
School of the eldest child (within the ETSB) *
Child #1 *
Please use format: (Full name),  (Age),  (Specify wich ETSB School attended, if applies)
** It is important that you provide the information for each child in your household
Child #2
Please use format: (Full name),  (Age),  (Specify wich ETSB School attended, if applies)
Child #3
Please use format: (Full name),  (Age),  (Specify wich ETSB School attended, if applies)
Child #4
Please use format: (Full name),  (Age),  (Specify wich ETSB School attended, if applies)
If more children, specify for each one:
Please use format: (Full name),  (Age),  (Specify wich ETSB School attended, if applies)
Please indicate if you have any food restrictions
Please indicate if you have requested assistance from another organization such as a local church, food bank CSSS, Panier de l'espoir, Estrie Aide, etc) *
In order to honour our generous donors and uphold the true spirit of the Christmas Basket Campaign, please note that any abuse or misuse of this assistance program may result in restriction or denial of future services. We work closely with other organizations within and outside the area to cross-check family names and ensure there is no duplication of services.
Reference *
Please provide the name of someone who is aware of your circumstances, whom we can contact, and who agrees to attest to your needs (e.g. A Principal, teacher, clergyman, social services/Student services professional, etc)
Select the grocery store for pick-up *
 ** Pick-up date, time & location will be communicated to you by phone **
It is the family's responsability to coordinate their own transportation to go get the baskets at the chosen grocery store.
For any specific needs or questions, please contact 
Ms. Anne-Marie Allaire at agrhs.baskets@edu.etsb.qc.ca
MAKING THE HOLIDAYS BRIGHTER & LIGHTER... FOR EVERYONE! 
A copy of your responses will be emailed to the address you provided.
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