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About Us
- History, Missions & Values
- Our Staff
Our Programs
Ways You Can Help
News
Events
- Gallery
- Calendar
Contact
DONATE

Community & Family Services

Initial Intake and Inquiry for services.

Step 1 of 5

20%

Are you a new client or returning client?*
- New client - this is my first time receiving services from any The Salvation Army
- Returning Client - I have received services in the past, but it was a long time ago and/or at a different location
- Current Client - I am currently or have in recent past received services from Ridge Meadows Ministries
- Unknown
Are you submitting this form on behalf of someone else?*
- Yes - I am submitting this form on behalf of my client
- Yes - I am submitting this form behalf of a family or friend
- No - I am submitting this form for myself/my household
Representative's information
Representative's Name*
First Last
Agency or organization*
Representative's Phone*
Representative's Email*
Enter Email Confirm Email
Who will be the person we follow up with to book an appointment?*
eg. If you are picking up a hamper on behalf of your client you would check "Myself" or "Other colleague/care provider".
- Myself
- Other colleague/care provider
- My client
Contact email to book pick up appointment*
Enter Email Confirm Email
Client's General Information
Applicant's Name*
First Last
Applicant's Date of Birth*

YYYY
MM
DD
Gender identity & preferred pronouns*
Proof of identification*
Valid identification, government issued ID is required in order to apply for serviced through The Salvation Army Ridge Meadows Ministries.
ID may include:
BC Drivers License (BCDL), Passport, Canadian Birth Certificate, BCID, BC Services Card, Canadian Citizenship Card, Permanent Resident Card, Canadian Record of Landing/Canadian Immigration Identification Record, or Indigenous Status Card.
- I will book an appointment to provide proof of identification in person
- I can not provide proof of identification
Do you need assistance getting photo ID?*
We may be able to help you get photo ID or work with other organizations to obtain this for you.
- Yes
- No
- Unknown
Marital Status*
How did you hear about us?*
Referring agency/organization*
Client's Contact Information
Contact conserns*
Check all that apply.
- No contact concerns
- Applicant does not have phone number
- Applicant does not have email
Applicant's Phone Number*
Applicant's Email*
Enter Email Confirm Email

Client's Financial Information
Please note: The level of service you will receive is not based on your income. We do not measure a client's need by the amount of money they make. Each application is reviewed on a case-to-case basis.
Has your financial information changed since your last visit?*
- Yes
- No
- Unknown
Sources of Household Income*
Please include all sources of how you make money. This must include all household members 19+ year of age. Check all that apply.
- NONE
- Full-time employment (35+ hours per week)
- Part-time employment
- Canadian Pension Plan (CPP)
- Canadian Recovery Benefit (CRB)
- Canadian Recovery Caregiving Benefit (CRCB)
- Canadian Recovery Sickness Benefit (CRSB)
- Child Tax Benefit (CTB)
- Child/Spousal Support
- Employment Insurance (EI)
- Guaranteed Income Supplement (GIS)
- Old Age Security (OAS)
- Pension from Former Employment
- Private Disability Insurance
- Provincial Disability Support
- Retirement Income
- Social Assistance
- Student Loans
- Veterans Disability Program
- Veterans Pension
- Other
Total MONTHLY Household Income*
Include all sources of INCOME (money deposited) from all people over 19 yrs of age.
Proof of household income*
Proof of your household income may be required in order to receive SOME services through The Salvation Army Ridge Meadows Ministries.
You may provide a screen shot or scan of your most recent income record. Either a current bank statement or most recent pay stub.
- I will book an appointment to provide proof of household income in person
- I can not provide proof of household income
Monthly Household Expenses*
Please include all sources of how you and your household spends money. Check all that apply.
- NONE
- Rent/mortgage
- Utilities (Hydro, gas, garbage, etc.)
- Internet/cable/home phone
- Cell phone
- Vehicle (loan payment, insurance, gas, etc.)
- Food/groceries/dining
- Loan repayment (credit cards, bankruptcy, student loans, etc.)
- Medical (treatments, specialists, prescriptions, etc..)
- Other
Total MONTHLY Household Expenses*
Include all EXPENSES you incur each month (a ball park estimated number is fine). You may leave this blank if you would prefer to speak in person.
Net MONTHLY cash on hand

Household Information
Has your housing situation or address changed since your last visit?*
- Yes
- No
- Unknown
Has anyone moved in or out of your household since your last visit?*
- Yes
- No
- Unknown
Your current housing situation:*
What shelter are you currently housed?*
What city do you reside in?*
Current Address*
Street Address Address Line 2 City Province Postal Code
How many other people live in your household?*
This includes family and/or roommates. Do not include separate suites on the same property. DO NOT INCLUDE YOURSELF/APPLICANT.
Please enter a value between 0 and 8.
Household Members
First family member/housemate:*
First Last
Date of birth*

YYYY
MM
DD
Is this birthdate estimated?*
- Yes, this is my best guess
- No, this is their exact birthday
Age*
Relationship to you*
Second family member/housemate:*
First Last
Date of birth*

YYYY
MM
DD
Is this birthdate estimated?*
- Yes, this is my best guess
- No, this is their exact birthday
Age*
Relationship to you*
Third family member/housemate:*
First Last
Date of birth*

YYYY
MM
DD
Is this birthdate estimated?*
- Yes, this is my best guess
- No, this is their exact birthday
Age*
Relationship to you*
Fourth family member/housemate:*
First Last
Date of birth*

YYYY
MM
DD
Is this birthdate estimated?*
- Yes, this is my best guess
- No, this is their exact birthday
Age*
Relationship to you*
Fifth family member/housemate:*
First Last
Date of birth*

YYYY
MM
DD
Is this birthdate estimated?*
- Yes, this is my best guess
- No, this is their exact birthday
Age*
Relationship to you*
Sixth family member/housemate:*
First Last
Date of birth*

YYYY
MM
DD
Is this birthdate estimated?*
- Yes, this is my best guess
- No, this is their exact birthday
Age*
Relationship to you*
Seventh family member/housemate:*
First Last
Date of birth*

YYYY
MM
DD
Is this birthdate estimated?*
- Yes, this is my best guess
- No, this is their exact birthday
Age*
Relationship to you*
Eighth family member/housemate:*
First Last
Date of birth*

YYYY
MM
DD
Is this birthdate estimated?*
- Yes, this is my best guess
- No, this is their exact birthday
Age*
Relationship to you*

How can we help you now and in the future?
If you select "future need" for any program or service below we will add your information to our contact list and notify you when this becomes available.
Emergency Food Hamper*
Receive a food hamper when you are in dire need.
- Immediate need
- Future need
- No need
Move Out Hamper*
Receive a one time hamper that contains pantry staples, housewares, etc. (hampers vary based on donated items on hand). Available to clients moving from our shelter or supportive housing into private housing.
- Immediate need
- Future need
- No need
Sonia's Cradle Hamper*
Receive monthly infant and toddler supplies for all children in your care, available to families with children 0-3yrs old.
- Immediate need
- Future need
- No need
Thrift Store Voucher*
Receive one voucher up to once per 6 months. This voucher is only good for receiving household goods and is only available to those moving in/out of transitional or supportive housing. CLOTHING VOUCHERS ARE NOT INCLUDED.
- Immediate need
- Future need
- No need
Adopt a Family - Christmas Hamper*
Receive a Christmas hamper with toys and food during the holidays, available to seniors and families
- Immediate need
- Future need
- No need
Back to School - School Supplies Hamper*
Receive school supplies for all school aged children and youth in your care.
- Immediate need
- Future need
- No need
Summer Camp*
Assistant and subsidy to help send the children in your care to summer camp. Over night summer camp is located on the Sunshine Coast.
- Immediate need
- Future need
- No need
Other*
Other service not listed, please add more details in the notes section below.
- Immediate need
- Future need
- No need
please specify "other"*
Are you currently registered with any Food Bank?*
- Yes
- No
If "yes" additional questions will follow.
Do you require a referral to the Friends in Need Food Bank?*
- Yes
- No
- Unknown
What challenges with your current food security services are you facing?*
- Can not access the food bank - due to mobility issues
- Can not access the food bank - due to hours of operation
- Poor quality or expired items
- No/limited diet specific items
- Not enough food
- Other
Please specify "other"*
How can we personalize your service?
Are there any dietary restrictions or food allergies in your household?*
- Yes
- No
- Unknown
Household Food Allergies*
If anyone in your home has the following allergies, please check all that apply:
- NONE
- Egg
- Gluten
- Dairy
- MSG
- Peanut
- Pork
- Seafood
- Sesame
- Soy
- Sulphite
- Tree Nuts
- Other (Specify)
- Prefer Not to Answer
- Don't Know
Household Dietary Restrictions*
If anyone in your home has the following dietary restrictions, please check all that apply:
- NONE
- Diabetic
- Halal
- Kosher
- Vegan
- Vegetarian
- Other (please specify)
- Don't Know
- Prefer Not to Answer
What cooking/food storage do you have access to?*
please check all that apply:
- Full size Refrigerator
- Mini/bar Refrigerator
- Full size stove and oven
- Counter top oven/toaster oven
- Microwave oven
- Hot plate
- Other
Transportation*
How will you be able to pick up your hamper if approved?
- Vehicle
- Bus
- Walking - no cart
- Walking - with cart
- I require delivery (restrictions may apply)
- Other
Please specify "other"*

At The Salvation Army, we collect and use your personal information to manage our programs, assess your eligibility for support, understand the needs of those we serve and improve our services. On an as-needed basis, we also share your personal information with other agencies to provide more complete support, eliminate duplication of efforts or fulfil our commitments to those who fund our programs. We obey strict standards of confidentiality when collecting, using and sharing or disclosing your personal information. Tell us if you would like to receive a copy of The Salvation Army Privacy Policy. Please know that:
- You have the right to receive a copy of the information about you that is stored in The Salvation Army Client Management System and or The Salvation Army Link2Feed Client Intake software.
- You have the right to correct mistakes in information about you. Our resources and ability to serve your community depend in part on the information provided by our clients.
Our resources and ability to serve your community depend in part on the information provided by our clients.
*
- I have read and understood the information above and by signing this document I agree that The Salvation Army may collect, use and disclose my personal information for the purposes mentioned above. I also agree that my personal information may be entered into The Salvation Army Client Management System and or The Salvation Army Link2Feed Client Intake software.
*
- In applying for assistance from The Salvation Army on behalf of my household, and sharing information about my family members, I confirm that I am sharing this information with the knowledge and permission of all household members age 18 and over (AB, SK, MB, ON, PE, QC) or age 19 and over (BC, NT, NU, YT, NB, NL, NS).
APPLICANT'S NAME (DIGITAL SIGNATURE)*
First Last

About Us

History, Missions & Values
Our Staff

Spiritual Care

Church & Spiritual Care

Shelter & Housing

Emergency Shelter
Genesis Transitional Housing

Community & Family Services

The Salvation Army Christmas Village gift program
Back to School
Community Meals
Emergency Food Hampers
School Lunch Bag
Sonia’s Cradle
Summer Camp

Contact Us

Administrative Office
23315 Dewdney Trunk Road
Maple Ridge, BC V2X 3L6
(604) 463-8296 ext. 108

Housing Facility
22188 Lougheed Hwy.
Maple Ridge, BC V2X 2S8
(604) 463-8296 ext. 102

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