Adopt-a-Family Support Request Form

Thank you for visiting Closer to Home’s Adopt-a-Family Request Form page.

2025 Applications are now OPEN!

For more information regarding other Community Support Programs, please visit www.ab.211.ca. 

*Please note that we cannot guarantee a successful application due to the number of families requesting support this holiday season; however, we are trying our best to support as many as possible.

Adopt-a-Family Support Request Form 2025

Select your gender 
Select your nationality 
*New Canadian is a recent immigrant to Canada, but has not yet obtained Canadian Citizenship.
Select your ethnicity/culture 
Select your status 

Adults in the Household

Adult #1 – Your Information (Applicant)

Select your gender 
Self

Adult #2

Select your gender 
Select your relationship 

Adult #3

Select your gender 
Select your relationship 

Adult #4

Select your gender 
Select your relationship 

Adult #5

Select your gender 
Select your relationship 

Adult #6

Select your gender 
Select your relationship 

Adult #7

Select your gender 
Select your relationship 

Adult #8

Select your gender 
Select your relationship 

Adult #9

Select your gender 
Select your relationship 

Adult #10

Select your gender 
Select your relationship 

Adult #11

Select your gender 
Select your relationship 

Adult #12

Select your gender 
Select your relationship 

Adult #13

Select your gender 
Select your relationship 

Adult #14

Select your gender 
Select your relationship 

Children in the Household

Child #1

Select your gender 
Select your relationship 

Child #2

Select your gender 
Select your relationship 

Child #3

Select your gender 
Select your relationship 

Child #4

Select your gender 
Select your relationship 

Child #5

Select your gender 
Select your relationship 

Child #6

Select your gender 
Select your relationship 

Child #7

Select your gender 
Select your relationship 

Child #8

Select your gender 
Select your relationship 

Child #9

Select your gender 
Select your relationship 

Child #10

Select your gender 
Select your relationship 

Child #11

Select your gender 
Select your relationship 

Child #12

Select your gender 
Select your relationship 

Child #13

Select your gender 
Select your relationship 

Child #14

Select your gender 
Select your relationship 

Additional Information

Any other considerations when describing your family that Closer to Home should be aware of?
Is anyone pregnant in the household?*
Select annual income 
In the last year, have any of the following circumstances caused a loss in household income (select all that apply)*
Are you currently registered with OR receiving support from any of the following programs (select all that apply)
Have you ever received services from Closer to Home in the past?*
Closer to Home services (select any that apply)*
Drop files here or Drop file
Examples of Proof of Income are Notice of Assessment OR recent pay stubs from all working parties in the household. Closer to Home does reserve the right to request proof of income at any time should you choose not upload at this time.

All information submitted through this form adheres to Closer to Home's Privacy Policy and will not be shared.
Do you feel like there are any other details surrounding your request for support that Closer to Home should be aware of?
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