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Privacy Information
Personal information is being collected under the authority of the Child and Family Services Act (R.S.O. 1990, c. C.11), the Child Care and Early Years Act (S.O. 2014, c. 11, Sched. 1), and will be used by the Region and external service providers contracted by the Region for the purposes of: assigning referrals to a special needs resourcing agency, who will contact you to arrange for services; and, for improving the planning and delivery of services by way of surveys and questionnaires conducted by the Region of Peel in its role as service system manager. Questions about this collection should be directed to: Advisor, Early Years and Child Care Services, Region of Peel, 10 Peel Centre Drive, Suite B, P.O. Box 2136 STN B, Brampton, ON, L6T 0E3, by mail, or by telephone at (905) 791-7800 ext. 7264.

Where this consent is being provided for a child, I certify that I am a person who has legal custody of the child and therefore the legal authority to provide this consent for the child.

I consent and certify