Ontario Works Release of Information Form

Ontario Works Participant gives permission to the YMCA of Niagara Employment and Immigrant Services staff to provide information, both verbally and/or written to: Niagara Region Community Services (Social Assistance and Employment Opportunities). The participant also understands that all information provided and shared will be kept completely confidential and not provided to any other source or party without their direct approval and permission.
By entering my name below, I acknowledge that my Service Provider has explained its use and disclosure of my personal information for its purpose.
This consent is valid for 1 year after program closure date.