Image
Contact
English (Canada)
English (Canada) Français du Canada العربية 简体中文 ਪੰਜਾਬੀ Español de Colombia فارسی Українська Tiếng Việt Kiswahili አማርኛ اردو
[google-translator]
English (Canada)
English (Canada) Français du Canada العربية 简体中文 ਪੰਜਾਬੀ Español de Colombia فارسی Українська Tiếng Việt Kiswahili አማርኛ اردو

Your Personal Details

DD slash MM slash YYYY

Current Residential Address

Immigration Related Information

DD slash MM slash YYYY
DD slash MM slash YYYY
DD slash MM slash YYYY
DD slash MM slash YYYY
DD slash MM slash YYYY
Please upload documents to verify your current legal status in Canada (maximum 5 documents; maximum 10mb per document)
Drop files here or
Accepted file types: pdf, docx, doc, jpg, gif, tiff, Max. file size: 10 MB, Max. files: 5.

    Details of Family Members

    Would you like to register your family members so that they can also receive services with us?

    Member 1

    DD slash MM slash YYYY

    Member 2

    DD slash MM slash YYYY

    Member 3

    DD slash MM slash YYYY

    Member 4

    DD slash MM slash YYYY

    Member 5

    DD slash MM slash YYYY

    Member 6

    DD slash MM slash YYYY

    Consents and Confidentiality Statement

    The Inter-Cultural Association of Greater Victoria (ICA) will collect and keep personal information about clients1 confidential unless there is a reason to be worried about someone’s safety. If there is a concern for safety (including harm to self or harm to others), the Code of Ethics of Canada requires breaking confidentiality. Also, by law, every member of Canadian society is required to report concerns about a child’s safety. 

    If needed, ICA staff will use client information in other ICA programs only with consent from the client.

    Other Consent(Required)
    DD slash MM slash YYYY
    Clear Signature

    CANADA’s ANTI-SPAM LEGISLATION - UNDERSTANDING AND AGREEMENT TO EXPRESS CONSENT FORM

    Canada’s Anti-Spam Legislation (CASL) dictates that the Inter-Cultural Association of Greater Victoria (ICA) is prohibited from sending a Commercial Electronic Message (CEM) by any electronic means (i.e. email, SMS text, instant message, social media) without first obtaining the express consent of the recipient either verbally or in writing.

    ICA would like to confirm your interest in us communicating with you through sending you periodic e-mail and SMS text communications, including but not limited to, appointment reminders and changes, ICA Workshops of interest, electronic newsletters, appeals for donations, invitations to events, and other announcements.

    ICA will keep your information confidential and will not share your information with other organizations.

    By signing below, you have been made aware that you:

    • are giving your express consent so that ICA can communicate with you through any electronic means.
    • can contact ICA at any time to withdraw your express consent by contacting ICA’s Settlement Client Navigator at (250) 388-4728 ext. 120 or unsubscribing to communications that you receive.
    Email Consent(Required)
    DD slash MM slash YYYY
    Clear Signature
    DD slash MM slash YYYY
    Clear Signature
    This field is hidden when viewing the form
    This field is hidden when viewing the form
    DD slash MM slash YYYY
    This field is hidden when viewing the form
    This field is hidden when viewing the form
    Image

    808 Douglas St., Suite 102, Victoria, British Columbia V8W 2B6 Canada

    (250) 388-4728 |

    reception@icavictoria.org

    Powered by

    Image

    CARMIS (Case Management Solution for Non-Profits)