Subscribe
Section Française
Accessibility
Publications
Annual Reports
About Us
Our History
Our Vision, Mission, Values & Strategies
Kerry’s Place Board of Directors
Our Senior Staff
The Family Advisory Committee
Residential Clinical
Annual Reports and Financial Statements
Publications
Services & Supports
Donate
Employment
Contact Us & Feedback
About Us
Our History
Our Vision, Mission, Values & Strategies
Kerry’s Place Board of Directors
Our Senior Staff
The Family Advisory Committee
Residential Clinical
Annual Reports and Financial Statements
Publications
Services & Supports
Donate
Employment
Contact Us & Feedback
EmploymentWorks Intake Form
NEED HELP BY PHONE?
Toll Free:
1-833-77-KERRY (1-833-775-3779)
or
email
us at
intake@
null
kerrysplace.org
Participant's Full Name
*
First
Last
Participant's Age
*
If the participant is not completing this intake form on their own behalf, please include participant's Parent/Guardian’s name
First
Last
Please indicate the best email to reach individual completing this form
*
Please indicate the number to best call/text individual completing this form
*
Please indicated your prefered method of receiving communications
Select All
email
text
Please indicate which date you are interested in attending
Service Region
*
--- please select your region ---
Toronto Region
York/Simcoe Regions
Peel/Halton Regions
Dufferin/Wellington/Waterloo Regions
East Region (Durham, HKPR, Northumberland, Hastings)
Other
If "other" was specified, please add your region below
Δ
THANK YOU FOR YOUR MESSAGE.
WE WILL REPLY TO YOUR MESSAGE WITHIN 2 BUSINESS DAYS.
Tweet
Share
Share
