Online Intake

JVS Toronto – Online Intake

Registration Form

Please fill in the following information to register for JVS Toronto programs and services. A representative will contact you within 24 hours. Please note that at this time all JVS Toronto employees are working remotely, and as such the return call may come from an anonymous phone number. We look forward to connecting with you soon.

First Name *

Last Name *

I am interested in the following Program Area(s). Please check all that apply *

Employment Services

Disability Services

Assessments and Psychology Services

OtherOther

Gender *

Gender

Date of Birth

Mailing Address *

City *

Postal Code *

Email Address *

Primary Phone Number *

Secondary Phone Number

Family Status

First Language

Other Languages

English Language Proficiency

Country of Origin

Newcomer Arrival Date

Citizenship Status *

Highest Level of Education

Country Where Education was Attained Country Where Education was Attained

Primary Source of Income

Reason for coming to JVS

How did you hear about JVS

Name of Referrer

Questions or Comments

Informed Client Consent to Collect, Use and Disclose Personal Information

Privacy of personal information is an important principle to JVS Toronto. We are committed to limiting the collection of information to what is necessary for the purposes identified by JVS Toronto to allow JVS Toronto to provide necessary services for a respective client. We also limit use and disclosure of personal information for purposes other than those for which it was collected.

Personal information will only be collected by fair and lawful means and includes any factual or subjective information, recorded or not, about an identifiable individual, such as: age, name, income, opinions, evaluations, etc. JVS Toronto ensures that we will not disclose personal information to third parties without your consent, unless we are legally required to do so. JVS Toronto has a number of security safeguards in place to protect your information.

I acknowledge that I understand the purpose for which my personal information is being collected and I authorize the collection, use, storage and disclosure of my personal information by JVS Toronto.

Canadian Anti-Spam Legislation Consent

JVS Toronto requests your consent to send electronic messages about the agency (unrelated to your program/service) such as notices, announcements, events and fundraising activities. For more information on Canada’s anti-spam laws, visit www.fightspam.gc.ca. For JVS Toronto’s privacy policies, visit www.jvstoronto.org/privacy-policy.

You can change your mind and withdraw your consent by contacting your JVS Toronto representative. *

I consent to receive electronic messages using my email address on file.

I do not consent to receiving electronic messages.

Rules and Regulations

JVS Toronto aims to provide a safe, inclusive and welcoming environment in which all individuals are treated with respect and dignity. Clients are expected to treat all individuals with respect including staff and other clients; any form of verbal abuse will not be tolerated. JVS Toronto staff has the discretion to give out warnings and/or revoke client privileges to access programs, services for not adhering.

Signature *

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Date

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