Facing Your Fears Online Interest Form

Home | Facing Your Fears Online Interest Form

Disclaimer:  An integral part of this program is parent/caregiver involvement. Please be advised that a parent/primary caregiver is required to participate in each group session. Additionally, parents/primary caregivers will be responsible for completing weekly homework assignments with their children.

Note: If your child displays behaviours that are disruptive to the group during group sessions, individual service may be recommended at that time.

Information Collection Notice: This intake form is used to determine clinician assignment, suitability of service, and prepare for our initial contact with you. The information collected will be stored in your child’s confidential client record and will only be accessible by those actively involved with your service.


Stay Connected

Name(Required)
By submitting this form, you are consenting to receive marketing emails from: Kinark Child and Family Services, 7271 Warden Ave, Markham, ON, Ontario, L3R 5X5, CA, http://www.kinark.on.ca. You can revoke your consent to receive emails at any time.
This field is for validation purposes and should be left unchanged.

This site uses cookies

By continuing to browse or by clicking accept, you agree to the storing of cookies on your device to enhance your site experience and for analytical purposes. To learn more, please see our privacy policy

Accept