I do hereby consent releasing and/or disclosing personal information related to my child
to the participating agencies as listed below.
PARTICIPATION AGENCIES
Participating agencies include Winnipeg School Division, Winnipeg Regional Health Authority, Manitoba Justice, Winnipeg Police Service, City of Winnipeg, General Child, and Family Services Authority (GA), Manitoba Housing, Employment, and Income Assistance (EIA), Child and Youth Services, Department of Families, Aurora Family Therapy, Victim Service, Probation Service, and newcomer community-based umbrella organizations such as Ethno-Cultural Council of Manitoba (ECCM), MANSO etc.
I am consenting to the collection and disclosure of information pertaining to the youth in my care (as listed above) to the participating agencies to allow for collaborative planning pursuant to the Bilal Community and Family Center Newcomer Community Mobilization
Initiative for the purpose of:
- Early identification of risk factors and/or barriers to safety, stability, and success
- Coordination of multi-agency case planning for children, youth, and families
- Mobilization of public and/or private, community and family support
- Navigational support
- Proactive planning to reduce crisis and crisis intervention and support.
I understand the following:
- I understand that the risk of self-harm or harm to another will be reported.
- I know that I can withdraw my consent at any time by calling the staff of the Bilal Community
and Family Centre.
- Information about the BCFC project, the process, and the role of the hub has been provided to me.
- I authorize the sharing of personal (including where necessary personal health) and individual/family information amongst Hub members as outlined above.
This consent is valid for 356 days from the date I sign this document and, I understand that I can withdraw this Consent in writing at any time and I may do so by contacting the Bilal Community and Family Center Newcomer Community Mobilization Initiative program coordinator at 204-880-2483.
