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Contact
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Français du Canada
Français du Canada English (Canada)

Intake Request Form

Your Personal Details

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Current Residential Address

Immigration Related Information

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Il peut s'agir d'une confirmation de résidence permanente, d'un permis de travail, d'un document de demandeur d'asile, d'une carte de résident permanent, etc.

Si vous téléchargez une carte de résident permanent ou un autre document recto-verso, veuillez vous assurer les deux les côtés sont attachés.
Déposer les fichiers ici ou
Types de fichier acceptés : pdf, docx, doc, jpg, gif, tiff, Taille maximum des fichiers : 10 MB, Nombre maximum de fichiers : 1.

    Emergency Contact Information

    Prestations de service

    Details of Family Members

    Would you like to register your family members so that they can also receive services with us?

    Member 1

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    Member 2

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    Member 3

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    Member 4

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    Member 5

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    Member 6

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    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.

    Clear Signature
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    +1 (204) 421-1421

    info@carmis.ca

    Location 1

    525 W 8th Ave Vancouver, BC, V5Z 1C6 Canada

    Location 2

    215-10 Fort Street, Winnipeg, Manitoba, R3C 1C4 Canada

    Alimenté par

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