• At Kerry’s Place Autism Services (Kerry’s Place), our Mission is to enhance the quality of life for persons with Autism Spectrum Disorder (ASD) and to empower them and their families, through evidenced, innovative and person- directed supports.

THE KERRY'S PLACE SERVICE AGREEMENT IS BETWEEN KERRY'S PLACE AUTISM SERVICES AND...

Name (Person with ASD Diagnosis)(Required)
Name of Parent/Guardian, if applicable

BY ACKNOWLEDING THIS AGREEMENT, THE SIGNATORIES UNDERSTAND THAT:

  • Kerry’s Place is committed to respecting your rights and all those whom we work with.
  • Kerry’s Place is committed to providing services and supports that are free from abuse by taking every reasonable precaution to minimize such risk. As required by law, staff must report all incidents of suspected abuse or neglect to the appropriate authority. Kerry's Place has a duty to report to their local child welfare agency should they be concerned about a child's welfare while providing any service. Further, as per our policy, any suspected or alleged abuse or mistreatment of an adult with ASD receiving services from Kerry’s Place will be reported to Kerry’s Place management and appropriate authorities as deemed necessary.
  • Kerry’s Place is committed to ensuring due care is provided across the service sector and, as such, is responsible to report concerns regarding service provision by third party providers to the appropriate authorities, should any concerns be brought to our attention.
  • Kerry’s Place may require your participation in rights and abuse awareness education for specific services. You can always request additional training or resources on rights and abuse.
  • It is important to provide accurate and up to date information regularly. Kerry’s Place will collect and use personal information solely for the purposes of providing the supports and services you agree to receive and in accordance with any disclosure obligations to public authorities. We will treat all personal information as confidential in accordance with applicable laws.
  • Audio and video-recording of services delivered is not permitted by members of the public. Should a family/guardian/participant have extenuated circumstances for audio or video recording they must make a written request to commence the Audio/Video Approval and Consent Process. No audio or video recording shall be conducted prior to the completion of this process.
  • When services are delivered in a family/guardian or participant’s home or in a community setting, Kerry’s Place requires a safe and accessible environment for its employees and contractors to deliver such services and for an appropriate mediator to be available to participate as required. Should a circumstance interfere with this, the Clinical Supervisor or Manager will review options for continuing service delivery.
  • Kerry’s Place encourages everyone to bring forward recommendations and concerns so they may be addressed in a fair and equitable manner. Should a family/guardian or participant need to discuss a service or voice a concern, please contact the reporting manager of the service provided or follow the feedback process found on our website.
  • A Schedule of Service (if applicable) will outline any user fee, duration of service and, if required, the fee for additional support that exceeds the recommended support ratio. All fees are paid in advance of service delivery, unless alternate arrangements have been made for payment.

PLEASE ACKNOWLEDGE EACH OF THE BELOW:

(Required)
(Required)
  • Statement of Rights
  • Abuse Prevention and Responsibility
  • Confidentiality Policy
  • Complaints/Feedback Process
  • French Language Services Act
  • Standards and Best Practices
  • Use of Telepractice
  • Purchase Service Terms and Conditions
  • Cancellation Fees and Refunds
  • Code of Conduct
  • Privacy of Information for Persons Supported and Their Families
  • Family Charter of Commitments
(Required)

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