Senior and People with Disability Grocery Request (COVID-19 Protection) GTA
Assalamu Alaikum,

Corona Virus has proven to be more dangerous for elderly and disabled people. Many countries, including Canada, have started to take serious measures to reduce the spread of the virus. In Canada, many mosques have reduced or cancelled programs and interactions between community will be reduced as a result.

Allah (SWT) does not take away opportunities to earn reward, and as such, while many programs where large gathering of people is expected are being cancelled, those who wish to do good in the community can benefit from this program.

This form is to be filled for seniors in the Muslim community who are 65+ years in age or are disabled and find it challenging to obtain groceries amid the COVID19 pandemic.

Please note the following:

1. You can only request important and basic items (not exceeding 10-12 items)

2. All charges for the groceries must be e-transferred to or paid online at

3. Filling out this form does not guarantee that groceries will be delivered. The services are dependent on volunteer availability.

For anyone unable to fill this form, please email with the following details:
1. Name
2. Phone
3. Age
4. Address
5. List of items needed (not exceeding 10)
Email address *
Full Name *
Your answer
Phone Number *
Your answer
Email Address
Your answer
Address *
Your answer
Language *
Payment Options *
List of items
Your answer
Notes and Comments
Your answer
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