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Crisis Care Facility (C.C.F.) – Exemption Request Form

Purpose of the Exemption Process

Under Section 17 of the Town of Ajax Crisis Care Facility By-law, the Director may grant exemptions from specific requirements if satisfied that the exemption maintains the general intent and purpose of the by-law. Use this form to request relief from one or more sections, providing clear justification for your request. The Director may impose conditions on any exemption granted.

Requested Exemption – Section(s)

Reasoning for the Exemption Request

Applicant Contact

Attestation

Please check each box to confirm your understanding and agreement
 

Personal Information Notice: Personal information contained on this form is collected under the authority of the Municipal Act and will be used for the consideration and/or approval of a Crisis Care Facility Exemption Request. Questions about this collection should be directed to the Records & Freedom of Information Coordinator at 65 Harwood Avenue South, Ajax, Ontario, L1S 2H9. (905) 619-2529 ext. 3343.