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Refugee Claimants - Intake Form

Your Personal Details

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Current Residential Address

Immigration Related Information

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Emergency Contact Information

Consents and Confidentiality Statement

Mail Consent

I consent to your organization collecting, storing, and using my personal information for the purposes of providing services and communications related to events, workshops, and other relevant activities. I understand that appropriate security measures will be in place to protect my data from unauthorized access or misuse.

I consent to the sharing of my personal information with trusted third-party partners of your organization solely for the purpose of delivering services and communications as described. I am aware that I have the right to withdraw my consent at any time, which may impact the services provided to me.

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Clear Signature
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5th Floor - 491 Portage Ave, Winnipeg, Manitoba, R3B 2E4

204.786.9251

Alimenté par

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CARMIS (Solution de gestion de cas pour les organisations à but non lucratif)