Meal Registration | Meals on Wheels London, Ontario

"The food is good for you and tastes great. Plus, no dishes, no traveling and no tipping!"

Meal Registration

Complete this form if you're wanting to begin a meal program. The intake coordinator will call you to complete the registration.

Client Information

Name: *

Address Line 1: *

Address Line 2:

City / Town: *

Postal Code: *

Phone Number: *

Date of Birth: *

Name of person completing this form: *

Phone Number of person completing this form: *

Client Details

How did you find out about our program?:

Are you interested in the standard meal program or the frozen meal program? : *

Standard Meal Program

Frozen Meal Program

Any food allergies?:

Any difficulties chewing or swallowing?:

Diet restrictions? (eg diabetic, No added salt):

Emergency Contact #1 Information

Name:

Address Line 1:

Address Line 2:

City / Town:

Postal Code:

Phone Number:

Emergency Contact #2 Information

Name:

Address Line 1:

Address Line 2:

City / Town:

Postal Code:

Phone Number:

Comments / Questions / Requests:

What's New

Meals on Wheels – Sponsor Edition!

Meals on Wheels London is proud to launch Meals on Wheels - Sponsor Edition Fundraiser! On September 21, 2010 get more than a meal. Formerly Meals…to Go, the Sponsor Edition fundraiser provides the best meal you’ll ever receive, the one that keeps on giving.

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