English (Canada) English (Canada) Français du Canada ECRC Client Intake FormYour Personal DetailsFirst Name(Required)Middle NameLast NameDate of Birth(Required) Marital Status(Required)MarriedSingleDivorcedWidowedCommon-LawGender(Required)FemaleMaleUnknownNon-BinaryMB Health Card #MB Family Health Card #Language spoken at Home(Required)EnglishFrenchAfrikaansAlbanianAmharicArabicArmenianBengaliBisayaBurmeseCantoneseCatalanCebuanoChineseChinese - SimplifiedChinese - TraditionalCreoleCroatianCzechDanishDutchFarsi (Persian)FilipinoGermanGujaratiHiligaynonHindiHungarianIlicanIlocanoIndonesianItalianItsekiriJapaneseKarenKinyarwandaKoreanMalagasyMalayalamMandarinMarathiMizoNepaliOther Middle Eastern LanguagesPashtoPolishPortuguesePunjabiRomanianRussianSerbianShonaSinhaleseSloveneSomaliSpanishSwahiliTagalogTamilTeluguThaiTigrignaTurkishUkrainianUrduVietnameseYorubaAcholiAdaAffarAfghanAkaAkanAklanonAkraAmerican Sign Language (ASL)Anuak (Anywa)AranAshantiAssameseAssyrianAzeriBahasa IndonesianBalochiBambaraBamileke / GhomalaBansoBantuBauleBelarusianBelenBembaBembeBeniBeninBerberBetiBhariBicol/Bikol/BicolanoBijaiyaBilenBiniBissaBontokBraille (translation only)BretonBulgarianBurji / Bembala / Bambala / DaashiBusanBusangoChakmaChaldeanChaochoChavacanoChichewaChinChiuchowChiyaoChowchauConcaniCreeDagaareDariDaza / Dazaga / TebuDinkaDioulaDzongkhaEdoEfikEsanEstonianEweFangFantiFe'fe / Fe'efe'e / Nufi / BafangFinnishFlemishFoochowFoukiFoullahFukineseFulaniGaGaelicGeorgianGrebo/KrumenGreekGuerzeHainamHakha ChinHakkaHararaHararyHargarHassanyaHausaHebrewHindkoHokkinIbibioIboIcelandicIdomaIgboIgorotIjawIkaIlongoIshanIvbiosakonIziJaraiJavaneseJingpoJolayJuba ArabicKacchiKakwaKanareseKandahariKankaniKannadaKapampanganKashmiriKazakhKenyang / Nyang / Banyang / ManyangKhmerKifuliruKihavuKihemba/Hemba/Kiluba-HembaKikambaKikongoKinnauriKinyamulengeKiregaKirundiKiswahiliKitubaKonkaniKpelleKrioKurdishKurmanjiKyrgyzLa langue des signes québécoise (LSQ)LaotianLariLatvianLebaneseLengieLingalaLithuanianLowmaLugandaLugishuLutoroMabanMacedonianMacenaMacuaMahouMakondeMalayMaligoMalinkeMalteseMandeMandingoMasalitMashiMendeMinaMoldovanMongolianMooreNaandi/CemualNdebeleNgiemboonNgombaNorwegianNubianNuerNzimaOkoOkpeOriyaOromoOsalOther African LanguagesOther Chinese DialectsOther European LanguagesOther LanguagesOther Signed LanguagesOther South Asian LanguagesOther South East Asian Lang.OtuhoPahariPampangoPangasinanPeulPhuockienPidginPlautdietschPoularRohingyaRomaniRukigaRunyankoleRutooroSahoSamoanSangoSanskritSaraScoulaSechuanSenufoSerbo-CroatianSesothoSeswiSeychellesShanShanghaiShansaiShillukSign LanguageSindhiSlovakSonghaiSoninkeSoraniSothoSoussouSouthern BurunSuesueSukumaSwazaiSwedishSwiss GermanTaichewTamasheqTariTatarTatshaneseTemneTeochewTibetanTichiewTigreTiminiTivToishanTshilubaTsibulaTwiUdukUhroboUigrigmaUmbunduUnamaUnknownUyghurUzbekVisayanWarayWelshWestern Hemisphere Indian LangWolofXhosaYacoubaYako/Loko/LokaaYekhee/Afenmai/AfemaiYiboeYiddishZandeZshilubaZugandaZuluPreferred Language of service(Required)EnglishFrenchEmail Address(Required) Phone Number(Required)Family SizeOther Spoken Languages (if applicable)EnglishFrenchAfrikaansAlbanianAmharicArabicArmenianBengaliBisayaBurmeseCantoneseCatalanCebuanoChineseChinese - SimplifiedChinese - TraditionalCreoleCroatianCzechDanishDutchFarsi (Persian)FilipinoGermanGujaratiHiligaynonHindiHungarianIlicanIlocanoIndonesianItalianItsekiriJapaneseKarenKinyarwandaKoreanMalagasyMalayalamMandarinMarathiMizoNepaliOther Middle Eastern LanguagesPashtoPolishPortuguesePunjabiRomanianRussianSerbianShonaSinhaleseSloveneSomaliSpanishSwahiliTagalogTamilTeluguThaiTigrignaTurkishUkrainianUrduVietnameseYorubaAcholiAdaAffarAfghanAkaAkanAklanonAkraAmerican Sign Language (ASL)Anuak (Anywa)AranAshantiAssameseAssyrianAzeriBahasa IndonesianBalochiBambaraBamileke / GhomalaBansoBantuBauleBelarusianBelenBembaBembeBeniBeninBerberBetiBhariBicol/Bikol/BicolanoBijaiyaBilenBiniBissaBontokBraille (translation only)BretonBulgarianBurji / Bembala / Bambala / DaashiBusanBusangoChakmaChaldeanChaochoChavacanoChichewaChinChiuchowChiyaoChowchauConcaniCreeDagaareDariDaza / Dazaga / TebuDinkaDioulaDzongkhaEdoEfikEsanEstonianEweFangFantiFe'fe / Fe'efe'e / Nufi / BafangFinnishFlemishFoochowFoukiFoullahFukineseFulaniGaGaelicGeorgianGrebo/KrumenGreekGuerzeHainamHakha ChinHakkaHararaHararyHargarHassanyaHausaHebrewHindkoHokkinIbibioIboIcelandicIdomaIgboIgorotIjawIkaIlongoIshanIvbiosakonIziJaraiJavaneseJingpoJolayJuba ArabicKacchiKakwaKanareseKandahariKankaniKannadaKapampanganKashmiriKazakhKenyang / Nyang / Banyang / ManyangKhmerKifuliruKihavuKihemba/Hemba/Kiluba-HembaKikambaKikongoKinnauriKinyamulengeKiregaKirundiKiswahiliKitubaKonkaniKpelleKrioKurdishKurmanjiKyrgyzLa langue des signes québécoise (LSQ)LaotianLariLatvianLebaneseLengieLingalaLithuanianLowmaLugandaLugishuLutoroMabanMacedonianMacenaMacuaMahouMakondeMalayMaligoMalinkeMalteseMandeMandingoMasalitMashiMendeMinaMoldovanMongolianMooreNaandi/CemualNdebeleNgiemboonNgombaNorwegianNubianNuerNzimaOkoOkpeOriyaOromoOsalOther African LanguagesOther Chinese DialectsOther European LanguagesOther LanguagesOther Signed LanguagesOther South Asian LanguagesOther South East Asian Lang.OtuhoPahariPampangoPangasinanPeulPhuockienPidginPlautdietschPoularRohingyaRomaniRukigaRunyankoleRutooroSahoSamoanSangoSanskritSaraScoulaSechuanSenufoSerbo-CroatianSesothoSeswiSeychellesShanShanghaiShansaiShillukSign LanguageSindhiSlovakSonghaiSoninkeSoraniSothoSoussouSouthern BurunSuesueSukumaSwazaiSwedishSwiss GermanTaichewTamasheqTariTatarTatshaneseTemneTeochewTibetanTichiewTigreTiminiTivToishanTshilubaTsibulaTwiUdukUhroboUigrigmaUmbunduUnamaUnknownUyghurUzbekVisayanWarayWelshWestern Hemisphere Indian LangWolofXhosaYacoubaYako/Loko/LokaaYekhee/Afenmai/AfemaiYiboeYiddishZandeZshilubaZugandaZuluPreferred/Other NameLevel of EducationHigh School or LowerPre-university/Post SecondaryCertificate/Diploma/ApprenticeshipBachelor DegreeMaster DegreePh.D.OtherSecondary PhoneCurrent Residential AddressAddress(Required)Apt/Unit #CityWinnipegBrandonPortage la PrairieThompsonSelkirkSteinbachWinklerAgassiz Provincial ForestAlexanderAlonsaAltonaAnolaArborgAshernAubignyAustinBaldurBasswoodBeausejourBelmontBenitoBerens RiverBeulahBinscarthBirnieBirtleBissettBlumenortBoissevainBrochetBrookdaleBrunkildCampervilleCarberryCarmanCartwrightChurchillCooks CreekCormorantCowanCranberry PortageCrandallCross LakeCrystal CityCypress RiverDarlingfordDauphinDeloraineDominion CityDufresneDugaldEast BraintreeEastervilleEddystoneEdenEdwinElginElieElkhornElm CreekElmaEmersonEricksonEriksdaleEthelbertFalcon LakeFisher BranchFisher RiverFlin FlonFork RiverFoxwarrenFraserwoodGardentonGilbert PlainsGillamGimliGirouxGladstoneGlenboroGlenellaGods Lake NarrowsGrand BeachGrand RapidsGrandviewGretnaGrunthalGypsumvilleHadashvilleHamiotaHartneyHazelridgeHeclaHodgsonHollandIle Des ChenesIlfordInwoodIsland LakeKelwoodKentonKillarneyKleefeldKomarnoLa BroquerieLa SalleLac BrochetLac du BonnetLandmarkLangruthLeaf RapidsLibauLindenLittle Grand RapidsLockportLoretteLowe FarmLundarLynn LakeMacGregorMafekingManigotaganManitouMarchandMcAuleyMcCrearyMelitaMiamiMiddlebroMiniotaMinnedosaMintoMoose LakeMordenMorrisNeepawaNelson HouseNewdaleNivervilleNorway HouseNotre Dame de LourdesOak LakeOak RiverOakbankOakvilleOchre RiverOtterburneOxford HousePansyPeguisPelican RapidsPikwitoneiPilot MoundPinawaPine DockPine FallsPine RiverPineyPlum CouleePlumasPointe du BoisPoplar RiverPoplarfieldPrawdaRandolphRapid CityRathwellRed Sucker LakeRennieRestonRicherRiversRivertonRoblinRolandRorketonRosaRoseau RiverRosenortRosewoodRossburnRussellSandilandsSandy LakeSanfordSartoSchanzenfeldSeven Sister FallsShamattawaShiloShoal LakeSidneySiftonSnow LakeSnowflakeSomersetSourisSouth Indian LakeSouth JunctionSperlingSplit LakeSpragueSt. AdolpheSt. ClaudeSt. Francois XavierSt. Jean BaptisteSt. LaurentSt. LazareSt. MaloStarbuckSte. AgatheSte. AnneSte. Rose du LacSteep RockStonewallSt-Pierre-JolysStrathclairSundownSwan LakeSwan RiverTadoule LakeTeulonThe PasThicket PortageTolstoiTourondTreherneTyndaleVassarVirdenVitaWaasagomachWabowdenWanlessWasagamingWaterhenWawanesaWhitemouthWinnipeg BeachWinnipegosisWoodlandsWoodmoreWoodridgeZhodaProvince(Required)ManitobaPostal Code(Required)Immigration Related InformationStatus in Canada(Required)Blended Visa Office-Referred Program (BVOR)Citizen by birthDiplomat - with Work PermitDiplomat - without Work PermitEmployer ContactGAR - Government Assisted RefugeesInternational ContactNaturalized CitizenPermanent Resident - Approved in PrinciplePermanent Resident - Live-in CaregiverPR - Permanent ResidentPrivate Sponsored Refugees (PSR)Protected PersonProvincial Nominee (PNP)Provincial Nominee Awaiting PRRC - Refugee ClaimantRefugee Claimant - with Work PermitRefugee Claimant - without Work PermitStudent - International Post SecondaryStudent - Study PermitTemp. Resident Permit / Minister's PermitTFW - Work Permit - Temporary Foreign WorkerUkraine CUAET PermitVisitor Visa - Temporary Resident VisaWork PermitWork Permit - CaregiverWork Permit - Entrepreneur/Self-employedWork Permit - International Mobility ProgramWork Permit - Post-Graduation Work PermitWork Permit - spouse/common-law partnerUCI/IUC (Unique Client Identifier)(Required)UCI/IUC (Unique Client Identifier)Country of OriginAfghanistanAlbaniaAlderneyAlgeriaAmerican SamoaAndorraAngolaAnguillaAntigua and BarbudaArgentinaArmeniaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBosnia and HerzegovinaBotswanaBrazilBritish Virgin IslandsBruneiBulgariaBurkina FasoMyanmar (formerly Burma)BurundiCameroonCanadaCanary IslandsCabo VerdeCayman IslandsCentral African RepublicChadChileChina (PRC)ColombiaComorosCongo Democratic Republic ofCongo (Congo Republic)Costa RicaCroatiaCubaCyprusCzechia (Czech Republic)DenmarkDjiboutiDominican RepublicEcuadorEgyptEl SalvadorEnglandEquatorial GuineaEritreaEstoniaEthiopiaGermanyFijiFinlandFr. PolynesiaFranceFrench GuianaGabonGambiaGeorgiaGhanaGreeceGreenlandGrenadaGuadaloupeGuamGuatemalaGuineaGuinea-bissauGuyanaHaitiHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsraelItalyCote d Ivoire (Ivory Coast)JamaicaJapanJordanKazakhstanKenyaKerguelen IslandsKyrgyzstanKiribatiKorea, NorthKorea, SouthKosovoKuwaitLaosLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgNorth MacedoniaMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMauritaniaMauritiusMexicoMoldovaMonacoMongoliaMontserratMoroccoMozambiqueNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNorthern IrelandNorwayPakistanPalestinePanamaPapua New GuineaParaguayPeruPhilippinesPitcairn IslandsPolandPortugalPuerto RicoQatarReunionRomaniaRussiaRwandaSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaScotlandSenegalSerbiaSeychellesSierra LeoneSingaporeSolomon IslandsSomaliaSouth AfricaSpainSri LankaSt. HelenaSt. Kitts and NevisSt. LuciaSt. Pierre Et MiquelonSt. Vincent And The GrenadinesStatelessSudanSurinameEswatini (formerly Swaziland)SwedenSwitzerlandSyriaTajikistanTanzaniaThailandTibetTogoTongaTrinidad & TobagoTunisiaTurkeyTurkmenistanTurks & CaicosTuvaluU.S. Virgin IslandsUnited States of AmericaUgandaUkraineUnited Arab EmiratesUruguayUzbekistanVanuatuHoly See (Vatican City)VenezuelaVietnamWalesWestern SaharaYemenYugoslaviaZambiaZimbabweOmanSudan, SouthUnited KingdomSloveniaSlovakia (Slovak Republic)Taiwan (ROC)CambodiaDominicaEast Timor (Timor-Leste)MicronesiaMontenegroPalauDate of Arrival Immigration Document(Required)This can be a Confirmation of Permanent Residence, a Work Permit, a Refugee Claimant document, a Permanent Resident Card, etc.If uploading a Permanent Resident Card or other two-sided document, please ensure both sides are attached. Drop files here or Select files Accepted file types: pdf, docx, doc, jpg, gif, tiff, Max. file size: 10 MB, Max. files: 1. Emergency Contact InformationFull Name(Required)Phone Number(Required)Email ServicesHidden(Required)Settlement ServicesSchool Related Services (SWIS)EmploymentYouth ProgramHave you accessed other services since coming to Canada?How Did You Hear About UsNot ReferredCommunity centre / libraryEmployer / co-workerEthnic or religious organizationFamily / friendsCanadian government agencyGovernment publication / brochure / websiteImmigration consultant / lawyerInternal to my organizationNon-governmental newspaper / media / publication / brochure / Web siteIn-Canada orientation sessionOverseas orientation session (e.g. CIIP)Other settlement service providerSchoolRecruitment via Destination Canada and Canadian embassiesRecruitment via website and social mediaWalk-inWhat are the general needs for your family now?Details of Family MembersWould you like to register your family members so that they can also receive services with us? Yes No How many members would you like to add?(Required)123456Member 1First Name(Required)Last Name(Required)Date of Birth(Required) Status in Canada(Required)Blended Visa Office-Referred Program (BVOR)Citizen by birthDiplomat - with Work PermitDiplomat - without Work PermitEmployer ContactGAR - Government Assisted RefugeesInternational ContactNaturalized CitizenPermanent Resident - Approved in PrinciplePermanent Resident - Live-in CaregiverPR - Permanent ResidentPrivate Sponsored Refugees (PSR)Protected PersonProvincial Nominee (PNP)Provincial Nominee Awaiting PRRC - Refugee ClaimantRefugee Claimant - with Work PermitRefugee Claimant - without Work PermitStudent - International Post SecondaryStudent - Study PermitTemp. Resident Permit / Minister's PermitTFW - Work Permit - Temporary Foreign WorkerUkraine CUAET PermitVisitor Visa - Temporary Resident VisaWork PermitWork Permit - CaregiverWork Permit - Entrepreneur/Self-employedWork Permit - International Mobility ProgramWork Permit - Post-Graduation Work PermitWork Permit - spouse/common-law partnerEconomic Class - RNIPTemporary residentGender(Required)FemaleMaleUnknownNon-BinaryMarital Status(Required)MarriedCommon-LawSingleRelationship(Required)SpouseChildSiblingParentCommon Law SpouseUCI/IUC (Unique Client Identifier)Member 2First Name(Required)Last Name(Required)Date of Birth(Required) Status in Canada(Required)Blended Visa Office-Referred Program (BVOR)Citizen by birthDiplomat - with Work PermitDiplomat - without Work PermitEmployer ContactGAR - Government Assisted RefugeesInternational ContactNaturalized CitizenPermanent Resident - Approved in PrinciplePermanent Resident - Live-in CaregiverPR - Permanent ResidentPrivate Sponsored Refugees (PSR)Protected PersonProvincial Nominee (PNP)Provincial Nominee Awaiting PRRC - Refugee ClaimantRefugee Claimant - with Work PermitRefugee Claimant - without Work PermitStudent - International Post SecondaryStudent - Study PermitTemp. Resident Permit / Minister's PermitTFW - Work Permit - Temporary Foreign WorkerUkraine CUAET PermitVisitor Visa - Temporary Resident VisaWork PermitWork Permit - CaregiverWork Permit - Entrepreneur/Self-employedWork Permit - International Mobility ProgramWork Permit - Post-Graduation Work PermitWork Permit - spouse/common-law partnerEconomic Class - RNIPTemporary residentGender(Required)FemaleMaleUnknownNon-BinaryMarital Status(Required)MarriedCommon-LawSingleRelationship(Required)SpouseChildSiblingParentCommon Law SpouseUCI/IUC (Unique Client Identifier)Member 3First Name(Required)Last Name(Required)Date of Birth(Required) Status in Canada(Required)Blended Visa Office-Referred Program (BVOR)Citizen by birthDiplomat - with Work PermitDiplomat - without Work PermitEmployer ContactGAR - Government Assisted RefugeesInternational ContactNaturalized CitizenPermanent Resident - Approved in PrinciplePermanent Resident - Live-in CaregiverPR - Permanent ResidentPrivate Sponsored Refugees (PSR)Protected PersonProvincial Nominee (PNP)Provincial Nominee Awaiting PRRC - Refugee ClaimantRefugee Claimant - with Work PermitRefugee Claimant - without Work PermitStudent - International Post SecondaryStudent - Study PermitTemp. Resident Permit / Minister's PermitTFW - Work Permit - Temporary Foreign WorkerUkraine CUAET PermitVisitor Visa - Temporary Resident VisaWork PermitWork Permit - CaregiverWork Permit - Entrepreneur/Self-employedWork Permit - International Mobility ProgramWork Permit - Post-Graduation Work PermitWork Permit - spouse/common-law partnerGender(Required)FemaleMaleUnknownNon-BinaryMarital Status(Required)MarriedCommon-LawSingleRelationship(Required)SpouseChildSiblingParentCommon Law SpouseUCI/IUC (Unique Client Identifier)Member 4First Name(Required)Last Name(Required)Date of Birth(Required) Status in Canada(Required)Blended Visa Office-Referred Program (BVOR)Citizen by birthDiplomat - with Work PermitDiplomat - without Work PermitEmployer ContactGAR - Government Assisted RefugeesInternational ContactNaturalized CitizenPermanent Resident - Approved in PrinciplePermanent Resident - Live-in CaregiverPR - Permanent ResidentPrivate Sponsored Refugees (PSR)Protected PersonProvincial Nominee (PNP)Provincial Nominee Awaiting PRRC - Refugee ClaimantRefugee Claimant - with Work PermitRefugee Claimant - without Work PermitStudent - International Post SecondaryStudent - Study PermitTemp. Resident Permit / Minister's PermitTFW - Work Permit - Temporary Foreign WorkerUkraine CUAET PermitVisitor Visa - Temporary Resident VisaWork PermitWork Permit - CaregiverWork Permit - Entrepreneur/Self-employedWork Permit - International Mobility ProgramWork Permit - Post-Graduation Work PermitWork Permit - spouse/common-law partnerGender(Required)FemaleMaleUnknownNon-BinaryMarital Status(Required)MarriedCommon-LawSingleRelationship(Required)SpouseChildSiblingParentCommon Law SpouseUCI/IUC (Unique Client Identifier)Member 5First Name(Required)Last Name(Required)Date of Birth(Required) Status in Canada(Required)Blended Visa Office-Referred Program (BVOR)Citizen by birthDiplomat - with Work PermitDiplomat - without Work PermitEmployer ContactGAR - Government Assisted RefugeesInternational ContactNaturalized CitizenPermanent Resident - Approved in PrinciplePermanent Resident - Live-in CaregiverPR - Permanent ResidentPrivate Sponsored Refugees (PSR)Protected PersonProvincial Nominee (PNP)Provincial Nominee Awaiting PRRC - Refugee ClaimantRefugee Claimant - with Work PermitRefugee Claimant - without Work PermitStudent - International Post SecondaryStudent - Study PermitTemp. Resident Permit / Minister's PermitTFW - Work Permit - Temporary Foreign WorkerUkraine CUAET PermitVisitor Visa - Temporary Resident VisaWork PermitWork Permit - CaregiverWork Permit - Entrepreneur/Self-employedWork Permit - International Mobility ProgramWork Permit - Post-Graduation Work PermitWork Permit - spouse/common-law partnerGender(Required)FemaleMaleUnknownNon-BinaryMarital Status(Required)MarriedCommon-LawSingleRelationship(Required)SpouseChildSiblingParentCommon Law SpouseUCI/IUC (Unique Client Identifier)Member 6First Name(Required)Last Name(Required)Date of Birth(Required) Status in Canada(Required)Blended Visa Office-Referred Program (BVOR)Citizen by birthDiplomat - with Work PermitDiplomat - without Work PermitEmployer ContactGAR - Government Assisted RefugeesInternational ContactNaturalized CitizenPermanent Resident - Approved in PrinciplePermanent Resident - Live-in CaregiverPR - Permanent ResidentPrivate Sponsored Refugees (PSR)Protected PersonProvincial Nominee (PNP)Provincial Nominee Awaiting PRRC - Refugee ClaimantRefugee Claimant - with Work PermitRefugee Claimant - without Work PermitStudent - International Post SecondaryStudent - Study PermitTemp. Resident Permit / Minister's PermitTFW - Work Permit - Temporary Foreign WorkerUkraine CUAET PermitVisitor Visa - Temporary Resident VisaWork PermitWork Permit - CaregiverWork Permit - Entrepreneur/Self-employedWork Permit - International Mobility ProgramWork Permit - Post-Graduation Work PermitWork Permit - spouse/common-law partnerGender(Required)FemaleMaleUnknownNon-BinaryMarital Status(Required)MarriedCommon-LawSingleRelationship(Required)SpouseChildSiblingParentCommon Law SpouseUCI/IUC (Unique Client Identifier)Consents and Confidentiality StatementMail Consent I consent to be added to the mailing list for information on events and workshops. IMAGE RELEASE FORM By granting us permission to use your image and/or experiences, you are assisting us in improving the Elmwood community in general, as well as building a greater awareness of the programs and services that are being provided by the ECRCAA. I grant permission to the Elmwood Community Resource Centre and Area Association (ECRCAA) to use my image and/or experiences to promote ECRCAA activities, events, and programs to its funders, government bodies. I, understand that my image and/or experiences may be used in posters, brochures, banners, websites, and advertisements (including newspaper, television, and outdoor) that the ECRCAA may produce to support its activities and projects. I revoke all claims to financial compensation for any of these treatments.Untitled Yes, I agree No, I do not agree Please either enter your initials here OR Sign in next boxSignature(Required)CaptchaPrograms (Admin Only)Date Visited (Admin Only) Official Language (Admin Only)Current Emp Status (Admin Only)DOC_1 TYPE
