New Client Registration For best results, please complete this form using Google Chrome. New Client Registration Last Name * First Name * Preferred Name (if different) Date of birth * Gender Identity * FemaleMaleNon-BinaryTransgenderTwo SpiritPrefer Not to SayOther (Specify) Gender Identity Marital Status * Common-LawDivorcedMarriedSeparatedSingleWidowedPrefer Not to SayOther Address - Street * Unit Number Province * AlbertaBritish ColumbiaManitobaNew BrunswickNew Founland and LabradorNova ScotiaOntarioPrince Edward IslandQuebecSaskatchewan City * Postal Code * Housing Type * Emergency Shelter / Mission / TransitionalEvacueeOwn HomePrivate RentalPublic (Social) HousingUnhousedWith Family/FriendsYouth Home/ShelterPrefer Not to SayOther Housing Type Email * Telephone * Photo Identification (Front of ID) Click to upload front of I.D. (Driver's License, BCID, PHN, Passport, Birth Certificate, etc.) Choose File Maximum file size: 10MB Please note: some individuals have been experiencing issues with uploading files. If you are having trouble, please contact us for help! Email [email protected] or call 250-763-7161. Photo Identification (Back of ID) Click to upload back of I.D. (Driver's License, BCID, etc.) Choose File Maximum file size: 10MB Please note: some individuals have been experiencing issues with uploading files. If you are having trouble, please contact us for help! Email [email protected] or call 250-763-7161. Proof of address (one piece required) Click to upload proof of address (Driver's License, Rent Receipt, Utility bill, tax receipt, etc.) Choose File Maximum file size: 10MB Please note: some individuals have been experiencing issues with uploading files. If you are having trouble, please contact us for help! Email [email protected] or call 250-763-7161. Spoken Language(s) * Racial Identities (Please select all that apply) * Arab Black Chinese Filipino Indigenous Japanese Korean Latin American South Asian (e.g., East Indian, Pakistani, Sri Lankan, etc.) Southeast Asian (e.g., Vietnamese, Cambodian, Laotian, Thai, etc.) West Asian (e.g., Iranian, Afghan, etc.) White Prefer Not to Say OtherOther Do you identify as a person with a disability? * YesNoPrefer Not To Say Have you been in Canada less than 10 years? * No, I have lived in Canada for more than 10 yearsYes - please enter Year and Month of Arrival to Canada Have you been in Canada less than 10 years? Are you a Refugee? * YesNo Are you currently attending a Post-Secondary College, University, or Institute? * YesNo Additional Household Members. Please fill this out for each additional household member (if none, please click "Remove") Last Name First Name Date of Birth Gender Identity FemaleMaleNon-BinaryTransgenderTwo SpiritPrefer Not to SayOther Gender Identity Relationship to You Boyfriend/GirlfriendChildCommon-Law PartnerFriendGrandchildGrandparentOther RelativeParentRoommateSiblingSpouseOther Relationship to You Does this household member identify as a person with a disability? YesNoPrefer Not To Say Has this household member been in Canada less than 10 years? No, I have lived in Canada for more than 10 yearsYes - please enter Year and Month of Arrival to Canada Has this household member been in Canada less than 10 years? Is this household member a refugee? YesNo Racial Identities (Please select all that apply) Arab Black Chinese Filipino Indigenous Japanese Korean Latin American South Asian (e.g., East Indian, Pakistani, Sri Lankan, etc.) Southeast Asian (e.g., Vietnamese, Cambodian, Laotian, Thai, etc.) West Asian (e.g., Iranian, Afghan, etc.) White Prefer Not to Say OtherOther Identification (Front of ID) Drop file here or click to upload (Driver's License, BCID, PHN, Passport, Birth Certificate, etc.) Choose File Maximum file size: 10MB Identification (Back of ID, if applicable) Drop file here or click to upload (Driver's License, BCID, PHN, Passport, Birth Certificate, etc.) Choose File Maximum file size: 10MB plus1 Add Member minus1 Remove Highest education level completed: * Grade 0-8Grade 9-11Grade 12OAC/GED/equivalentPost Secondary (some)Trade Certificate/Professional AccreditationCollege DiplomaUniversity DegreePhDOther Country of Education: * What is your household's primary source of income? * Employment IncomeChild SupportChild Tax BenefitCPP/PensionDisabilityEIEmployed: Part-TimeGST/HSTNet Room/Board or RentalNo IncomePrivate DisabilitySocial AssistanceStudent LoanOther (Specify) What is your household's primary source of income? Do any household members have dietary considerations or allergies? Allergies (Please Specify)Allergies (Please Specify) Celiac/Gluten-Free Halal - strict Halal - chicken okay Lactose Intolerant Vegan Vegetarian Do any household members have health conditions requiring specialized diets? Bone Disorder Cancer Crohn's Diabetes Fibromyalgia Heart Disease High Cholesterol IBD/IBS Pregnant Stroke Other (Please Specify)Other (Please Specify) Please attach any relevant medical documents here Drop a file here or click to upload Choose File Maximum file size: 10MB As a Member of Food Banks Canada, the Central Okanagan Food Bank stores and shares certain data for the purpose of advocating to reduce food insecurity across Canada. COFB will not share any personal or identifying information with Food Banks Canada, or any other agency. * I agree to having my information collected and shared anonymously with Food Banks Canada to advocate for programs and policy recommendations. Submit