Ontario Works Release of Information Form

Choose your YMCA of Niagara Employment Services location:

Participant gives permission for the Region of Niagara–Ontario Works to communicate directly, both verbally and in writing, with the YMCA Employment and Immigrant Service (EIS) Staff while their file is active with YMCA of Niagara Employment Services. Furthermore, Participant gives permission to the Region of Niagara and YMCA EIS Staff to share employment details while their file is active with YMCA of Niagara Employment Services.

Participant's name: *

First

Last

Participant's consent: *

I agree
I do not agree

Parent/guardian's name:

First

Last

If participant is under 16 years of age

Parent/guardian's consent:

I agree
I do not agree

If participant is under 16 years of age

Date: *

Participant's e-mail: *

This consent is valid for 1 year after program closure date.