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Gift of Giving Application Form

Step 1 of 5 – Consent to share information

Unique ID

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Applicant Consent

Bringing Holiday Cheer

As we enter the Christmas season, we are reminded of the joy that comes from giving and supporting those around us. Our goal is to help make this season a little brighter for families and individuals in need, bringing hope and holiday cheer to our community.

Why We Are Asking for Additional Information

To better align our support with the needs of the community, we now collect detailed information on household income, financial assistance, and experiences with grief and loss. This helps us ensure that our resources are reaching the families who need them the most.

Consent to Share Information

Please insert your initials as agreement to share your information. Your information will not be publicized and is only kept for data purposes to ensure our resources reach the families who need them the most.

Initials:(Required)

Type of Support Requested(Required)

How many people in the household?(Required)

Please enter a number from 0 to 10.

Adults(Required)

Please enter a number from 0 to 10.

Children(Required)

Please enter a number from 0 to 10.

Full Name of Senior:(Required)

First Last

Phone Number:(Required)

Home Address of Senior(Required)

Street Address Parish Zip Code:

Color of House(Required)

Does the household have a dog?(Required)

How many children?(Required)

Please fill in the information below for each child for up to 5 children

Child 1

Full Name:(Required)

First Last

Age Category:(Required)

Gender(Required)

Child 2

Full Name:(Required)

First Last

Age Category:(Required)

Gender(Required)

Child 3

Full Name:(Required)

First Last

Age Category:(Required)

Gender(Required)

Child 4

Full Name:(Required)

First Last

Age Category:(Required)

Gender(Required)

Child 5

Full Name:(Required)

First Last

Age Category:(Required)

Gender(Required)

Any questions ?

Gift of Giving Application Form

Applicant Consent

Applicant Information

Child 1

Child 2

Child 3

Child 4

Child 5

Any questions ?

Gift of Giving Application Form

Applicant Consent

Applicant Information

Child 1

Child 2

Child 3

Child 4

Child 5

BERMUDA'S INAUGURAL GRIEF & LOSS AWARENESS DAY