Blue Card Registration - The Inn of The Good Shepherd

Link2Feed Registration

"*" indicates required fields

Please note that you must attach your identification and all requested supporting documents along with this application form in order for your application to be accepted.

Please allow up to 2 weeks for your blue card to be available.

Client Information & Demographics

First Name*

Last Name*

Gender Identity

Date of Birth*

Phone*

Confirm Phone*

Address (including unit #)*

Street Address City Postal Code

No Fixed Address

Identification File Upload*

Drop files here or

Accepted file types: jpg, jpeg, png, pdf, word, Max. file size: 512 MB.

Upload a picture of an acceptable ID for each individual in your household (birth certificate, driver's license, photo health card)

Housing Type*

Please select one from the drop down list.

Lived in Canada for 10 years or less?*

Referred by:

Dietary Considerations

Racial Identity*

Highest Level of Completed Education

Do you have a disability?*

Household Members

List everyone in your household including yourself*

Full Name

Date of Birth

Gender

Relationship to you

Does this person have a disability?

Monthly Income & Expenses

Please list all income sources. At least 1 primary income source is required for the household*

Income Source

Income Amount

Who Earned the Income?

Monthly Housing Cost*

Monthly Housing Type*

Rent

Mortgage

Proof of residency upload*

Drop files here or

Accepted file types: jpg, jpeg, png, pdf, word, Max. file size: 512 MB.

Proof of Lambton County residency is required for all members in your household. If claiming children, please show residency by uploading your most recent statement from OW, ODSP, or Child Tax Credit. If it's an adult only household, please upload any one of the following items to verify your residency:

bank statement,
utility bill,
phone bill,
property tax receipt,
pay stub,
insurance policy,
EI benefit stub,
OW/ODSP benefit stub (showing the names of everyone in your household)

If you do not have access to any one of these documents, please connect with the Program Manager at 519-344-1746 x337.

Consent to Disclose & Verify Information

Please read the consent statement below. Signing/agreeing signifies that you understand this consent applies to yourself, your spouse or same-sex partner and child(ren) in your care.

Staff will only contact you at the phone number provided if there is an issue with your registration. Otherwise your Blue Card will be ready for pickup at reception. This may take up to 2 weeks. Thank you for your patience and understanding.

Please note that blue cards must be picked up from the reception desk at our 115 John Street location.

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