Caregivers in the Hills – ID Badge Application – Hills of Headwaters Collaborative

The benefits of applying for a Caregivers in the Hills identification badge

You will be recognized as a Caregiver by healthcare providers in the Hills of Headwaters Collaborative
It will give you confidence to ask questions to support your loved one
Providers will recognize you as a caregiver and it will provide validation of your role and presence in the healthcare setting
Facilitates you as a partner in care

Caregivers in the Hills - ID Badge Application

Please fill out this application form for the Caregivers in the Hills program. To successfully complete, you will need to have a photo of yourself prepared to upload for your Caregiver Identification Badge. This application may also be filled out over the phone. If you would prefer to do so, please call Caregivers in the Hills at 519-216-6671. We are currently accepting applications from unpaid caregivers who reside in Dufferin County or Caledon, or care for someone who does.

Name(Required)

First Last

Email(Required)

Phone(Required)

Are you an unpaid caregiver?(Required)

Yes

Third Choice

Who do you provide care for?(Required)

If you selected Other (please specify):

Date(Required)

This field is for validation purposes and should be left unchanged.

Caregivers in the Hills – ID Badge Application

The benefits of applying for a Caregivers in the Hills identification badge

Caregivers in the Hills - ID Badge Application

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