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Service Agencies
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" indicates required fields
City
*
Select a city...
Calgary
Edmonton
Winnipeg
Hinton
Airdrie
Lethbridge
Red Deer
Selkirk
Other
Name of Agency
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Address
*
Street Address
Address Line 2
City
Province
Alberta
British Columbia
Manitoba
New Brunswick
Newfoundland and Labrador
Northwest Territories
Nova Scotia
Nunavut
Ontario
Prince Edward Island
Quebec
Saskatchewan
Yukon
Province
Postal Code
Contact Name
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First
Last
Contact Email
*
Contact Phone Number
*
Which demographic(s) does your agency serve?
*
Please select all that apply.
Children (10 and under)
Youth (13-19)
Seniors
Members of Indigenous Nations
People belonging to a racialized group
Individuals with Disabilities
Individuals with Mental Health Concerns
Newcomers
LGBTQ2S+
Other
Demographic (Other)
*
If you selected other, please specify.
What type of social service does your agency provide?
*
Please select all that apply.
Shelter
Community Kitchen
School Food Program
Parents Group
Soup Kitchen
Food Bank
Street Outreach
Drop-In Centre/Safe Space
Resource Centre
Group Home or Supported Living Facility
Newcomer/Refugee Support Programs
Other
Social Service (Other)
*
If you selected other, please specify.
What type(s) of food program would donations be used for?
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Breakfast Program
Lunch Program
After School Program
Shelter or Drop-In Meal Service
Soup Kitchen
Hampers
Emergency Food Provisions (including snacks)
Door Service
Other
Food Program (Other)
*
If you selected other, please specify.
How many people do you serve per week?
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How many meals (or equivalencies) do you serve per week?
*
Which of the below foods can you accept?
*
Select all that apply.
Please note:
not all of these foods are available in all cities. Food is subject to availability of donations.
Bread (may be unsliced)
Pastries
Fruits
Vegetables
Frozen entrees (lasagna, meats, etc.)
Milk (if yes, you must have a refrigerator to store)
How many loaves of bread can you store?
*
Do you have a kitchen where you can prepare food?
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Yes
No
Please note any dietary needs of your community below.
*
(eg. Kosher, Halal, etc.)
What are your hours of operation?
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Please indicate if you operate over the weekend.
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Add Hours
When can you accept donations?
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Please list the days of the week and the time windows for each day—the broader the better.
Mon
Tue
Wed
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Add Hours
When can you accept donations? (Anytime)
Anytime during business hours
How frequently would you like to receive donations?
*
Be advised that we may not be able to meet your request for frequency.
Choose a frequency...
More than once per week
Weekly
Bi-weekly
Monthly
Do you have staff or volunteers who would be able to pick-up food from the donating vendor?
*
Yes
No
Please list any special instructions for drop-offs?
*
(i.e. location, what buzzer to ring, where to park, who to ask for)
Do you consent to Leftovers sharing posts and pictures about your organization?
*
Yes
No
Please type your social media handles below.
*
(eg. Instagram, Facebook, Twitter handle, hashtags, etc.)
Date of Submission
*
MM slash DD slash YYYY
Respect Agreement
*
For more information on Leftovers IDEA (Inclusiveness, Diversity, Equity and Accessibility) initiatives, go to
https://rescuefood.ca/IDEA
I understand that Leftovers operates on the principles of respect, inclusiveness, diversity, and anti-racism.
Respect Agreement 2
*
I recognize that Leftovers includes people of all races, genders, sexual orientations and religious beliefs in our recruitment of staff, volunteers, growers and partner organizations.
Respect Agreement 3
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I agree to demonstrate respect for all people and property when I’m participating in Leftovers programming.
Respect Agreement 4
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I acknowledge that Leftovers puts the safety of all individuals first.
By submitting this form, I agree that:
*
Our organization has read the
AHS Guidelines
and understand that it is our responsibility to comply
By submitting this form, I agree that:
*
Our organization has read the
Leftovers Food Donation Guidelines
and understand that it is our responsibility to comply
I also agree that:
*
Our organization will not accept any foods listed as unacceptable in the
AHS Guidelines
I also agree that:
*
Our organization will not accept any foods listed as unacceptable in the
Leftovers Food Donation Guidelines
Notifications