Free Goods Application Form | Calgary Drop-In Centre

Are you hoping to use the Free Goods Program?*

Yes, I would like to use the Free Goods Program
No, I am an administrator

What brought you to the Free Goods Program?*

I am applying on behalf of myself
I am a case manager or a referring agency

What is your name?*

First Last

Are you a client of the DI?*

Yes
No

What is your email address?*

What is the password used for administration bookings?*

What is the name of the person you are booking a Free Goods appointment for?*

First Last

The administrator option on this form is meant to be a placeholder for an appointment that was already booked manually/offline. As such, it will not have all the details of the Free Goods form. Please fill out the calendar below so that no one else can double book that time slot, and refer to the original booking for the details.

What is the name of the client you are applying for?*

First Last

What is your birthday?*

What is your client's birthday?*

What is your phone number?*

What is your client's phone number?*

What is your client's email address?*

If you do not have a cell phone or email address, please let us know what the best way to contact you is.

We will need to contact you to confirm your appointment, so please ensure we have at least one way to get in touch.

If your client does not have a cell phone or email address, please let us know the best way to contact

We will need to contact them to confirm your appointment, so please ensure we have at least one way to get in touch.

What is your your address?*

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

What is your client's address?*

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

If you're a current client at the DI, what is your case manager's name?

Which agency do you represent?*

When is the move-in date to your new home?

When is your client's move-in date?

The Free Goods Program is currently available to clients of the Calgary Drop-In Centre and to referrals from approved agencies. To learn which agencies can refer clients to the Free Goods Program, click here.

What items do you need?*

Select All
Furniture
Household Goods
Computer
Clothing

You can pick up to 5 furniture items. What would you like?

You have the option to select up to 5 items from the list below (1 each). Please do not select more than 5.

Bed Frame/Mattress
Chairs (Living Room)
Coffee/End Table
Couch/Loveseat
Desk
Dresser
Kitchen Table & Chairs
TV
Shelving Unit

What household goods are you looking for?

You may choose as many options as you want

Dishes/Cutlery
Lamps/Art/Decorations
Linen
Microwaves/Toaster
Pots & Pans
Radios/DVD players
Small Appliances
Vacuum
Baby/Child items

Please confirm that you are looking for a computer through our Computers for Low-Income (CLIC) program.

Yes I am looking for a computer through CLIC

Are you looking for a computer through our Computers for Low-Income Calgarians (CLIC) program?

Yes I am looking for a computer through CLIC
No, I am not

Have you stayed (former client) at the Calgary Drop-In Centre within the last six months?

Yes
No

Please note: the CLIC program is dependent on the generous support of our community, and as such we may not always have computers in stock. By registering for this program, you will be added to our list and will be contacted when a computer is available for you.

How many adults are living or will be living in the household?*

How many children are living or will be living in the household?*

Are there any other items you need?

If you know of something that you will need but did not see it on the list, please make a note of it here. Our Free Goods staff will talk about it with you when they confirm your appointment and see if anything can be done.

Are there any other items your client might need?

If you know of something that you will need but did not see it on the list, please make a note of it here. Our Free Goods staff will talk about it with you when they confirm your appointment and see if anything can be done.

When would you like to book your appointment with the Free Goods Program?*

What time on APRIL 1st would you like your appointment to be?*