Returning Client Intake Form

In providing service to a client, the different Centre Departments may be called upon to receive or share information about the client with external agencies with which they collaborate in serving the client. The Centre staff will not share personal information about the client with such agencies without the express consent of the client.

I hereby consent to the creation of a client file in my name by the Niagara Folk Arts Multicultural Centre, and to the collection in that file of information about me and my family essential for the purpose of providing service to me, and in compliance with the requirements of the agencies funding the service. I understand that Niagara Folk Arts Multicultural Centre staff will in no circumstance contact an external agency on my behalf or about me without my express permission on each occasion. I further understand that the disclosure or exchange of information about me and/or my family to external agencies is on an as-needed basis only, for the purpose of providing service to me. I understand that I may cancel my consent at any time except for such action as has already been taken.