CB Pickup | MCSS

Number of people in your household:*

Hidden

Send Notifications?*

Yes
No

Hidden

Approved?

Yes
No

User*

Hidden

Signature Option:*

NOTE: If your device does not work with the e-signature option, please select "Text Signature."

E-Signature
Text Signature

Hidden

Picked up?

Yes

Hidden

Picked-Up By:*

Applicant
Pick-Up Contact
Other

Approved By (MCSS Staff Name):*

Applicant Information

Name:*

First Name Last Name

Address:*

Street Address Address Line 2 City Province Postal Code

Do you want to add your email to make registration faster next year?*

Yes
No

Birthdate:*

Email*

Phone:*

Picture ID type:*

ID Number:*

Spouse Information (Optional)

Name:

First Name Last Name

Address:

Same as applicant address.

Street Address Address Line 2 City Province Postal Code

Birthdate:

Email

Phone:

Picture ID type:

ID Number:

Applicant's Monthly Income

Applicant's Monthly Income:*

Income Source	Monthly Amount

I am registering in-person at the Christmas Bureau and a staff member or volunteer has already approved my income verification.

I am registering in-person at the Christmas Bureau and a staff member or volunteer has already approved my income verification.

Staff confirmation code:*

Please have a staff member or volunteer enter this code to complete your registration.

Proof of income:*

Please attach any relevant bank statements, pay stubs, or other documents for the income listed above.

MOBILE ONLY: On mobile and tablet devices when tapping "Select files" you will have the option to select an existing picture/file or take a new picture using the device camera.

Drop files here or

Max. file size: 50 MB.

Registration Information

Registering for:*

Mission Food Centre: Food Hamper
Christmas Bureau Toys
Both

Do you want to be sponsored?*

Yes
No

Dietary restrictions:*

Yes
No

Please list any dietary restrictions:*

Number of Dependents*

Dependents*

All fields must be filled out. Age will auto-calculate and cannot be entered manually.

First Name	Last Name	Birthdate	Age	Gender	Medical ID

Hamper Pick-Up Information

Food Hamper Pick-up Dates:

For pick-up please arrive anytime from 9am - 5pm between:

December 7th - 16th, Monday - Friday

Location

Food Centre/Christmas Bureau
32646 Logan Ave
Mission, BC V2V 6C7

PLEASE NOTE: Toys and Hampers have different pickup locations.

Toy Pick-Up Information

Toy pick-up will be at the Mission Christmas Bureau at:

The Junction Shopping Centre
32555 London Ave, Mission, BC V2V 6M7

Christmas Bureau Toy Pick-up Dates:

Pick-up is based on last name, please arrive anytime during the time slot selected below.

PLEASE NOTE: Toys and Hampers have different pickup locations.

Toy Pick-Up Date:*

Toy Pick-Up Time:*

Pick-up Contact:

Same as applicant above.

Name*

First Name Last Name

Phone:*

Picture ID type:*

ID Number:*

Please list any additional information:

Authorization

Declaration 1*

I/We declare that the above information is true and give Mission Community Services Society and the Mission Food Centre/Christmas Bureau permission to verify this information.

Declaration 2*

I/We would like our information to be shared with MCSS Christmas Bureau for registration purposes only.

Signature Option:*

Please select an option to sign your registration.
NOTE: If your device does not work with the e-signature option, please select "Text Signature."

E-Signature
Text Signature

Applicant’s E-Signature:*

Applicant’s Text Signature:*

Date:*

Name

This field is for validation purposes and should be left unchanged.