Christmas Bureau Registration Number of people in your household:*-- Select --12-34-56+HiddenApproved? Yes User* HiddenSignature Option:*NOTE: If your device does not work with the e-signature option, please select "Text Signature." E-Signature Text Signature HiddenPicked up? Yes HiddenPicked-Up By:* Applicant Pick-Up Contact Other Approved By (MCSS Staff Name):* Applicant InformationName:* First Name Last Name Address:* Street Address Address Line 2 City British ColumbiaAlbertaBritish ColumbiaManitobaNew BrunswickNewfoundland and LabradorNorthwest TerritoriesNova ScotiaNunavutOntarioPrince Edward IslandQuebecSaskatchewanYukon Province Postal Code Do you want to add your email to make registration faster next year?* Yes No Birthdate:* YYYY dash MM dash DD Email* Phone:*Picture ID type:*-- Select --BC IDMedical IDDriver's LicenseIndian Status CardSecure Indian Status CardNexus CardPassportPermanent Resident CardID Number:* Spouse Information (Optional)Name: First Name Last Name Address: Same as applicant address. Street Address Address Line 2 City British ColumbiaAlbertaBritish ColumbiaManitobaNew BrunswickNewfoundland and LabradorNorthwest TerritoriesNova ScotiaNunavutOntarioPrince Edward IslandQuebecSaskatchewanYukon Province Postal Code Birthdate: YYYY dash MM dash DD Email Phone:Picture ID type:-- Select --BC IDMedical IDDriver's LicenseIndian Status CardSecure Indian Status CardNexus CardPassportPermanent Resident CardID Number: Applicant's Monthly IncomeApplicant's Monthly Income:*Income SourceMonthly Amount 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 Select files Max. file size: 50 MB. Registration InformationRegistering 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 NameLast NameBirthdateAgeGenderMedical ID -- Select One --MaleFemaleOther Hamper Pick-Up InformationFood Hamper Pick-up Dates: For pick-up please arrive anytime from 9am - 5pm between: December 8th - 16th, Monday - Friday Location Food Centre/Christmas Bureau32646 Logan Ave Mission, BC V2V 6C7Toy Pick-Up InformationToy 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.Toy Pick-Up Date:*-- Select Date --Wednesday, December 8th - A, BThursday, December 9th - C,DFriday, December 10th - E,FMonday, December 13th - G, H, I, JTuesday, December 14th - K, L, MWednesday, December 15th - N, O, P, Q, R, SThursday, December 16th - T, U, V, W, X, Y, ZToy Pick-Up Time:*-- Select Time --9am - 11am11am - 1pm1pm - 3pm3pm - 5pmToy Pick-Up Time:*-- Select Time --9am - 11am11am - 1pm1pm - 3pm3pm - 5pmToy Pick-Up Time:*-- Select Time --9am - 11am11am - 1pm1pm - 3pm3pm - 5pmToy Pick-Up Time:*-- Select Time --9am - 11am11am - 1pm1pm - 3pm3pm - 5pmToy Pick-Up Time:*-- Select Time --9am - 11am11am - 1pm1pm - 3pm3pm - 5pmToy Pick-Up Time:*-- Select Time --9am - 11am11am - 1pm1pm - 3pm3pm - 5pmToy Pick-Up Time:*-- Select Time --9am - 11am11am - 1pm1pm - 3pm3pm - 5pmPick-up Contact: Same as applicant above. Name* First Name Last Name Phone:*Picture ID type:*-- Select --BC IDMedical IDDriver's LicenseIndian Status CardSecure Indian Status CardNexus CardPassportPermanent Resident CardID Number:* Do you want to be entered into a draw to win a Christmas Tree? Yes No All winners will be contacted directly on Monday, December 6th. Please list any additional information:AuthorizationDeclaration 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:* MM slash DD slash YYYY NameThis field is for validation purposes and should be left unchanged. Registration Instructions Registration Instructions
