Agnola Care Homes — Waitlist Sign-Up
Agnola Care Homes Corp. is a non-profit opening supportive group homes for adults 18+ and a day program for ages 13 and up across the GTA, for people living with autism or mental health challenges. Our group homes offer private bedrooms with shared living spaces, and our staff provide hands-on help with activities of daily living (ADLs) such as personal care, meals and medication reminders. Joining the waitlist is free and does not commit you to anything. We will contact you as spaces open. Questions? Call Tanisha Cummings at 1-844-213-3453 or email tanisha@agnolacare.org.
About the person needing support
Full name of person needing support
*
First Name
Last Name
Date of birth
*
-
Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Gender
Male
Female
Non-binary
Prefer not to say
Other
City of residence
*
Primary diagnosis or support needs
*
Autism
Intellectual/developmental disability
Mental health
Other
Contact person
If the person is under 18, a parent or legal guardian must complete this form.
Contact person's name
*
First Name
Last Name
Relationship to person needing support
*
Please Select
Self
Parent
Guardian/Power of Attorney
Case worker/social worker
Other
Phone number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Email address
*
example@example.com
Preferred contact method
Phone
Email
Text
Services interested in
*
Group home (adults 18+, private room, shared living spaces, ADL support)
Day program (ages 13+)
Both (18+ only)
Preferred area(s)
Toronto
York Region
Durham
Peel
Halton
Simcoe/Barrie
Anywhere in the GTA
Ideal start timeframe
Please Select
As soon as possible
Within 3 months
3–6 months
6+ months
Just exploring
Support level
Can the person walk independently?
Yes
No
With aid
Can the person eat independently?
Yes
No
With help
Needs overnight support?
Yes
No
Not sure
Any behaviours of concern staff should know about?
Medications managed by
Self
Family
Needs staff support
Funding sources
*
Passport funding
ODSP
Family / private pay
Trust or Henson trust
DSO-matched funding
Not sure yet
Approximate monthly budget for services
Consent
*
I consent to Agnola Care Homes Corp. collecting this information to contact me about available spaces. Information is kept confidential.
I'd like to receive occasional updates from Agnola Care Homes.
How did you hear about us?
Please Select
Facebook
Kijiji
Church
Hospital or social worker
Agency or case worker
Friend or family
Other
Join Waitlist
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