2020 Christmas Bureau sign up form
Thank you for your interest in the 2020 Christmas Bureau. This year has been challenging for many of our community members. If you are a Gabriola resident that could use some support this Holiday season, you are invited to sign up for Christmas Bureau support. This includes a Nester’s gift card, and a small cheque for families with children.
* Required
Full Name
*
Your answer
Partner/Spouse full name (if applicable)
Your answer
Mailing Address (include postal code) If you do not have an address please write - no address
*
Your answer
Phone Number
Your answer
Email Address
Your answer
If you would like a PHC Holiday hamper (food items) please tick this box
Yes, I would like a PHC Holiday Hamper
Tick this box if you have transportation or other barriers, to request your Holiday Hamper to be delivered"
Yes, I would like my PHC Holiday Hamper to be delivered
If there are any special needs we should know about or specific questions you need follow up on, please enter them here:
Your answer
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