Access to Information / Disclosure Form

Centred Content

If you are currently receiving services from Durham CAS or have in the past, and would like access to your personal information, please fill our Access to Information/Disclosure form (*form opens in new window and is submitted on website).

You must attach one copy of valid government issued photo identification along with your request. Please note, the identification of any person age 16 years and older is required to release their information and must be included with your request. If you or any person age 16 years and older do not have identification, please note this in the Request Description field on the form.

A person with custody of a child under the age of 16 may request personal information of that child, subject to some exceptions. In some circumstances, you may be asked to provide documents confirming your authority to make the request in place of the child.

Completion of the Access to Information/Disclosure request form indicates that each party listed consents to the sharing of their personal and/or relevant information with the other consenting parties named on the form.

Purpose of Request:

Please choose one:(Required)

Personal Details

Name(Required)
Date of birth(Required)
Add child
If applicable, please list other individuals about whom you are requesting information. If you are requesting information about a child aged 16 years or older, please list their names below. Please note that for anyone aged 16 years or older, their identification must be included with your request to release their information.
First name
Last name
Date of birth (DD/MM/YYYY)
 

Contact Information

Address(Required)
Preferred phone number(Required)
Add an additional person who is 16 years or older
If applicable, please list other individuals about whom you are requesting information. If you are requesting information about another individual aged 16 years or older, please list their names below. Please note that for anyone aged 16 years or older, their identification must be included with your request to release their information.
First name
Last name
Date of birth – DD/MM/YYYY
Address
City
Phone Number
Email Address
 

Request Details

If possible, please provide additional details regarding the reason for your request as this will assist us to provide you with the information you require. If you or any person age 16 years and older do not have identification, please note this in the text box below.
Additional Information

Please attach information to support your request. You or any additional person aged 16 years and older is required to provide their identification.

No file chosenMax. file size: 300 MB.
No file chosenMax. file size: 300 MB.
No file chosenMax. file size: 300 MB.
No file chosenMax. file size: 300 MB.
Confirmation & Consent(Required)
Confirmation & Consent Checkbox 2(Required)
Confirmation & Consent Checkbox 3(Required)
Confirmation & Consent Checkbox 3

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