Record Correction [FRENCH]

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Personal Details

Name*

First Name Last Name

Alternate Name (e.g. maiden name, preferred name, alias)

Date of Birth*

Add Child

First Name

Last Name

Date of Birth (DD/MM/YYYY)

Address*

Number and Street Name Unit Number Ville Select Province Postal Code Pays

Phone Number*

Preferred Phone Number*

Home

Work

Cell

Email Address

Request Details

Details of Correction to Information*

Please describe in detail the personal information you wish to have corrected, explain why it is inaccurate or incomplete, specify the part of the record (including file and page number if possible), suggest the corrected wording, and provide any supporting information or documents to justify the correction. You may upload supporting documents or information below. Please click the plus (+) button to add an additional correction you would like to request be made to your record.

The information in the record I would like to correct is:

The information I would like to replace:

This information is inaccurate because:

Contact Information

Additional Information

You or any additional person aged 16 years and older is required to provide their identification. Please attach relevant document(s) to support your request.

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Additional Information File 1

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Additional Information File 2

Aucun fichier sélectionnéTaille maximum des fichiers : 300 MB.

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Additional Information File 3

Aucun fichier sélectionnéTaille maximum des fichiers : 300 MB.

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Additional Information File 4

Aucun fichier sélectionnéTaille maximum des fichiers : 300 MB.

File Upload

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Taille maximum des fichiers : 50 MB.

Confirmation & Consent*

I certify the above information to be accurate.

Confirmation & Consent Checkbox 2*

I consent to a search of the provincial Child Protection Information Network (CPIN) and of Durham Children’s Aid Society’s legacy system in order for the Society to fulfil my request.

Confirmation & Consent Checkbox 3*

I agree that my submitted data is being collected and stored by the Durham Children’s Aid Society. Please Note: The Durham Children’s Aid Society must abide by the privacy rules set out in the Child, Youth and Family Services Act, 2017.

Record Correction [FRENCH]

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Lorem superposés valise pourparlers rêver chiots rendez-vous naissance Eiffel myrtille.

Lorem superposés valise pourparlers rêver chiots rendez-vous naissance Eiffel myrtille.

Personal Details

Request Details

Contact Information

Additional Information

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