Seniors Community Programs Information Request

Contact Information

* Name

* Phone
xxx-xxx-xxxx

Email

Would you prefer to be contacted by phone or email? Phone
Email

* City / town Select City...Fort ErieGrimsbyLincolnNiagara FallsNiagara-on-the-LakePelhamPort ColborneSt. CatharinesThoroldWainfleetWellandWest Lincoln

Message Information

* Program interest Select one... Adult Day Program Healthy Safe and Strong Outreach Respite South Niagara Health and Wellness General information

* Subject

* Message

Notice of Collection

Any personal information or personal health information submitted will be collected, used, and disclosed, where applicable, by members of Regional staff according to the Municipal Freedom of Information and Protection of Privacy Act or the Personal Health Information Protection Act. Any information you share will only be used for the intended purpose for which it was provided.

For questions or comments about privacy practices, or for more information about the administration of the Municipal Freedom of Information and Protection of Privacy Act in Niagara Region programs, see Freedom of Information and Open Government.