Access to Information / Disclosure Form

If you are currently receiving services from the Children’s Aid Society of Algoma or have in the past, and would like access to your personal information, please fill our our Access to Information/Disclosure form below.

You must attach one copy of valid government issued photo identification along with your request.

Please note, the written consent of any person age 16 years and older is required to release their information and must be included with your request. They can complete the Consent to Disclose Information form and you can attach it to your request.

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.

"*" indicates required fields

Preferred Language of Service:

Preferred Language of Service:*

English

French

Personal Details

Name*

First Name Middle Last Name

Please list any previous legal names or aliases that you have used.

Date of Birth*

Contact Information

Address*

Number and Street Name Unit Number City Select Province Postal Code Country

Phone Number (primary)*

Phone Number (other)

Email Address

* When an Email address is provided, this indicates that you consent to the Society communicating with you via Email.

Request Details

Add Parents/Siblings

To ensure the most thorough and accurate search of our records, please indicate the names and birth dates of your parents and siblings:

First Name

Last Name

Date of Birth (MM/DD/YYYY)

Relationship to you

List your previous addresses

(ensure you list addresses that may coincide with the records you are requesting)

Request Description

In order to help us best meet your needs, please specify what information you are requesting.

Add Child

If applicable, please list other individuals about whom you are requesting information (Note: the written consent of any person aged 16 years and older is required to release their information and must be included with your request to obtain their information):

Further: If you are requesting information about a child under the age of 16, you must have custody of that child. If you do not have custody, a court order or the consent of the custodial parent is required.

Full Name

Date of Birth (MM/DD/YYYY)

Relationship to you and/or your Custody Rights if applicable

Additional Information

Please attach a copy of one piece of valid government issued photo identification. The photo ID must be clear and legible. Note that your request may be delayed if this form is incomplete and/or your ID is illegible.

Additional Information File 1

Max. file size: 300 MB.

Additional Information File 2

Max. file size: 300 MB.

Additional Information File 3

Max. file size: 300 MB.

Additional Information File 4

Max. file size: 300 MB.

Confirmation & Consent*

I certify the above information to be accurate.