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INTAKE FORM 2
Your email address and phone number are your identification. Please respond to our email messages and calls from volunteers. If you do not respond several times, we will be forced to close your account and will not be able to provide support.
By completing this application you will be added to our email list to be updated on support available to you.
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* Indicates required question
Email
*
Your answer
First Name
*
Your answer
Last Name
*
Your answer
Canadian phone number, or a Viber or WhatsApp number:
*
Your answer
What is your preferred way of communication?
*
Phone
Email
Facebook messenger
Whatsapp messenger
Telegram messenger
Viber
Other:
Required
Facebook messenger profile
Your answer
Contact information
(alternative phone number and email)
of any other adults in the family
(even they live in other country)
*
Your answer
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