Beneficiary Intake Application

Please completely fill out the information requested below. This information assists us in determining how we can best support you as well as how to put together a cloth diapering package that best suits your needs. All information that you provide is kept strictly confidential.

You can also download and print out the Beneficiary Intake Application PDF to submit by e-mail, fax, or mail.

You will also need to print out and sign the One Diaper Canada Beneficiary Waiver Form, to be uploaded with your application or sent to us via e-mail in order to process your application.

Beneficiary Intake Application

Contact Information

Application Details

Financial Information

In order for us to meet the qualifications required for a charity as set out by CRA, we are required to collect household income information. Again, please know that information provided is kept strictly confidential and is used only for us to ensure we best meet your needs. No information provided will be given to any other organization, including the organization which may have referred you to One Diaper Canada.


Drop a file here or click to upload Choose File
Maximum upload size: 2.1MB

We are a CRA registered charity!
Charity Registration Number: 806786398RR0001