Hygiene Kit Form

Please apply from here to receive the Hygiene kit package.

Hygiene Kit- a bath purse, shampoo, conditioner, toothbrush, toothpaste, sanitary pads, soap, and deodorant.

Hygiene kit is available thanks to generous donations from Procter & Gamble support from GlobalMedic & Soap For Hope Canada.

Hygiene Kit Form

First Name*

Last Name*

Pronouns*

How do you self identify?*

Email*

Phone*

Street*

City*

Province*

Age*

What is your marital status?*

How many dependants do you have in your home?*

How did you hear about our service?*

Are you considered as low-income ?*

Upload Proof of Income (e.g Notice of Assessment)*

File(s) size limit is 20MB.

Please confirm you are located in Victoria, BC*

I hereby read and understand all the Hygiene Kits Policies and conditions for applying for this program. I answered the form truthfully.

Please accept this

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Enrolled In Hygiene Kit

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