Farmer’s Market Nutrition Coupon Program Application 2026

Please provide us with the following contact information.

Name

Phone/Text

Email

Address

City

State/Province

Zip/Postal

Country

Do you live in any of these buildings?

About You:

How many people live in your household?

In your household, how many people are:

0-6 years old*

7-19 years old

Pregnant?*

Seniors/Elders?*

Living with a disability

*for the 2026 Farmer’s Market Nutrition Coupon Program, the Ministry of Health is prioritizing these households.

Do you identify as Indigenous?

Yes

No

If you identify as Indigenous, do you identify as any of the following?

First Nations

Metis

Inuit

OtherOther

Are you able to afford adequate amounts of fresh fruit and vegetables for you/your family?

Yes

No

What is your net yearly household income?

Does most of your income come from government assistance (CPP, OAS, GIS, Income Assistance, PWD)?

Yes

No

The 2026 Fernie Mountain Market operates from 10am-2pm every Sunday, from July 5th – September 27th. Can you commit to regularly participating in the Farmers Market Nutrition Coupon Program?

Yes

No

We are actively looking at ways to support our participants. Do you have any concerns regarding picking up your coupons or attending the market? If so, check what applies and provide descriptions regarding your concerns:

Health & Safety ConcernHealth & Safety Concern

TransportationTransportation

OtherOther

Consent

By selecting this box, I consent that I have read and agreed to the Farmers’ Market Nutrition Coupon Program Guidelines, and that I must be available to pick up my Nutrition Card . If my application is selected, I agree to be a part of the Farmers’ Market Nutrition Coupon Program. I understand the program provides fresh, local food for those who face financial challenges. I understand that these coupons are for my family’s personal use only.

Participant Name

Date

Farmer’s Market Nutrition Coupon Program Application 2026