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Intake Form

Universal Consent

Personal Information Notice and Consent

Release of Liability, Waiver of Claims and Indemnity Agreement

Gender

Male

Female

Undisclosed

Date Of Birth

Status / Identity

First Nations

Status

Non Status

Metis

Inuit

Non-Indigenous

Unknown

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Call: 905-871-8931

Email: reception@fenfc.org

796 Buffalo Road, Fort Erie, Ontario