Caregivers in the Hills – ID Badge – Phone Application

Caregivers in the Hills - ID Badge Phone Application

Please give us your contact information to apply over the phone for the Caregivers in the Hills program. A member of our team will give you a call to go over the application over the phone. If you have any questions please call us at 519-216-6671.

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):

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

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We acknowledge that Hills of Headwaters Collaborative and its partners work within the traditional territories and ancestral lands of the Tionontati (Petun), Attawandaron (Neutral), Haudenosaunee (Six Nations) and Anishinaabe peoples.