ErinoakKids - Day Respite Referral Form

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Home / Day Respite Referral Form

Please upload the Day Respite Referral Form*

Please select a file

Maximum 8 MB file size

Name of Person Submitting the Form(s)*

Contact Number for Person Submitting the Form(s)*

Contact Email for Person Submitting the Form(s)*

Please enter any additional information you would like us to be aware of:

Consent*

I Consent

This information is being submitted with the knowledge and consent of the parents/legal guardians. By providing the contact information with the form(s), you consent to receiving information about new service offerings, fundraising initiatives and free events offered at ErinoakKids by email, post, SMS/Text and other electronic means. ErinoakKids will always treat your personal details with the utmost care and will not share or sell your personal information. You may unsubscribe from receiving communications from ErinoakKids at any time. We are committed to keeping your information safe and confidential. We follow the rules set out in law about collecting, using and disclosing your personal information. For more information, please review our privacy policies publicly posted at https://www.erinoakkids.ca/privacy.