Cloth Diaper Subsidy

Information about the parentThis question is required.

First name•

Last name•

Phone number

Email•

Address•

Postal code•

Proof of residencyThis question is required.•

Please attach a copy of an official document specifying your mailing address

(e.g. municipal tax bill, school tax bill, Hydro-Quebec bill, driver's license, etc.)

Indicate your child's name•

Indicate your child's date of birth•

Please attach a copy of the child's health insurance card or birth certificate

Drop files here or click to upload them.

Attach a copy of your invoices•

Drop files here or click to upload them.

Save the information and complete the form later.