New Registration

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Child's Name *

First

Last

Child’s date of birth *

Parent's Name *

First

Last

Address *

Address Line 1

Address Line 2

City

State / Province / Region

Postal Code

Country

Phone number *

Email *

Which store would you like to shop from for food program? *

Select which store you like to shop from for the diaper program? *

NTI# Owner *

NTI number *

from card of

Child’s or Parent’s NTI Card *

Click or drag a file to this area to upload.

Child’s Health card or Birth Certificate *

Click or drag a file to this area to upload.

Name of person completing the application *

Declaration *

I confirm that the information provided is accurate, correct and complete and that the documents submitted along with this application form are genuine. Any incorrect or false information may result in denied application or funds owing to the City of Iqaluit to reimburse costs.

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