Cancer Support Haldimand

The Community Support Centre Haldimand-Norfolk is committed to providing compassionate, accessible, and non-clinical cancer-related support to individuals and caregivers in Haldimand. Eligible participants are individuals living with cancer at any stage of their diagnosis residing in Haldimand County.

Some of the ways we can help include:

  • Assistance with meals
  • Transportation costs
  • Parking assistance
  • Personalized support

Our team is here to offer support, understanding and comfort as you navigate your cancer journey.

“Strength, Light, Courage”.

Cancer Support Haldimand Application For Assistance

"*" indicates required fields

Date of Application

Application Information

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Applicant's Name*
Recipient's Name*
Recipient's Home Address*
Date of Birth
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Approximate date of diagnosis
PLEASE NOTE: If you are requesting items, please ensure you include estimates/receipts
Max. file size: 512 MB.

Applicant Release of Confidential Information

I certify that the above information is accurate, to the best of my knowledge. I also understand that this information is confidential and will not be released to others unless so directed by myself or unless law requires it. The information enclosed in the application will only be used for the CSH Program. I understand that my identity will be protected and kept confidential.
Typing your name in the signature box acts as your signature.
Date of Signature*

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