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Ottawa-Carleton Association for


Persons with Developmental Disabilities (OCAPDD)
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HOMESHARE PROGRAM – ENQUIRY FORM

Please complete the ENQUIRY FORM and click SEND to forward it to our attention. We will contact you as soon as possible.

Name

Address

Telephone

E-mail

How did you find out about this program?

Are there any smokers who reside in the home?

Yes No

If yes, where does he \ she smoke?

In the home Outside

What is the primary language spoken in the home?

Number of adults living in the home?

Number of children?

THANK YOU FOR COMPLETING THIS FORM AND FOR SHOWING INTEREST IN OUR PROGRAM.











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