Steinbach Community Christmas 2018

Hamper Registration

Please complete this form to register for a Christmas Hamper from South East Helping Hands. All fields must be completed with correct information to be eligible. One registration per household. Registrations must be submitted by November 30, 2018.

Hamper Recipient
Full name of person(s) receiving the hamper.
Recipient's Spouse/Partner
Children

Please add an entry for each child in your household. All children 17 years and under will receive gifts.

Other Adults

Please add an entry for each additional* adult in your household (*anyone 18 and over, not including your spouse listed above).

Address

Coverage Area

We service and deliver to Steinbach, Blumenort, Mitchell, and La Broquerie.

We service but do not deliver to Zhoda, Woodridge, Sandilands, St. Labre, and Marchand.

Areas which we do not service may be assisted by Grunthal Caring Hands Food Bank, Landmark, Niverville, Ste. Anne, RM of Tache, St. Adolphe, Dominion City, RM of Reynolds, Richer, Vita, or St. Pierre services. Click here for additional information on these organizations.

Please specify only the number of your house or driveway

Please specify only the name of your street

Please use only if you live in an apartment or multi-family dwelling

[use above address fields]

Please ensure this address is correct. It will be used to deliver your hamper.

You must live in one of the listed cities to be eligible for a hamper.

Primary phone number of recipient

Work or mobile phone number of recipient

If there is any additional delivery or address
information you would like us to know, please note it here.

Hamper Detail
Check the box(es) that apply to your current situation (required)

If you select 'Other', you must also specify the reason below

Please provide a brief description regarding your current life/financial situation. (All information is kept confidential.)

Are there any food allergies that you would like us to be aware of?

Alternate Hamper Registrant
Only complete this section if you are not the recipient of this hamper (ie. you're filling it out for someone else).

Relationship to recipient

We are unable to contact all recipients, so if you are registering for someone other than yourself, please let them know they are receiving a hamper. If you want to remain anonymous, please indicate below, and we will contact the recipient to arrange pick-up or delivery.

Pickup & Delivery Information

There are five different hamper pickup/delivery options:

Food Bank Clients

1. Food Bank Delivery Day (Wed. Dec. 12, 2:00-5:00pm)

  • I am a registered food bank client
  • I live within the delivery area
  • Hamper will be delivered on Wed. Dec. 12 between 2:00-5:00pm
  • Someone must be home to sign for the hamper

2. Food Bank Pick Up Day (Tue. Dec. 18, 3:00-7:00pm)

  • I am a registered food bank client
  • I live outside the delivery area or I prefer to pick up my hamper
  • I will pick my hamper on Tue. Dec. 18 between 3:00-7:00pm

General (Non-Food Bank) Clients

3. General Delivery Day (Fri. Dec. 14, 2:00-5:00pm)

  • I am not a food bank client
  • I live within the delivery area
  • Hamper will be delivered on Fri. Dec. 14 between 2:00-5:00pm
  • Someone must be home to sign for the hamper

4. General Pick Up Day (Tue. Dec. 18, 3:00-7:00pm)

  • I am not a food bank client
  • I will pick up my hamper at South East Helping Hands (525 Main St, Steinbach)
  • I will pick my hamper on Tue. Dec. 18 between 3:00-7:00pm

5. Church Delivery Day (Tue. Dec. 18, 1:00-3:00pm)

  • I would like my church to deliver my hamper
  • Hamper will be delivered on Tue. Dec. 18 between 1:00-3:00pm

You will receive an email confirmation once your hamper registration has been approved.

Please double-check all fields before submitting registration.