Family Court Support Program - Intake and Referral Form

Welcome to SASC's Online Intake Services
Thank you for your interest in our Family Court Support Program. Please take the time to fill out our online Intake & Referral Form to the best of your abilities. It should take about 10 minutes to complete. If you have any questions or need assistance to complete the form, please reach out to our office at 519-571-0121 x 108 or courtsupport@sascwr.org.

The purpose of this form is to streamline the intake process. If you are not comfortable answering any of these questions, or do not know the answer, please feel free to skip to the next question. To continue onto our Family Court Support Program Referral and Intake Form, please click "Next."

Family Court Support Program Terms & Conditions
Please read the information below about the Program's Terms & Conditions:

The Family Court Support Worker’s role is to provide support to clients who have experienced any form of abuse in their relationship and who are involved in or are beginning, the family court process. The Family Court Support Worker can:

- Provide information about the Family Court process
- Assist clients to apply for/appeal Legal Aid
- Assist in documenting the history of abuse for court documents
- Do safety planning, especially related to going to court
- Provide appropriate referrals and resources based on individual client needs
- Support clients to follow through on requests from their lawyer
- Debrief and discuss court outcomes, lawyer appointments, and/or next steps.
- Provide, where appropriate, accompaniments to court proceedings and lawyers appointments. This needs to be arranged in advance with the Family Court Support Worker. Accompaniments at times may be provided through a team of trained and supervised family court volunteers.

The Family Court Support Worker will respond to all communication as soon as possible, which may take up to 3 business days. For immediate crisis support, clients can utilize our 24-hour support line at 519-741-6461.

The Family Court Support Worker CANNOT:

- Provide legal advice. Only a lawyer can do this.
- Make legal decision on behalf of the client. We can help you explore your options, but all decisions are up to you.
- Speak on your behalf. For example, we can help you make a list of things to talk about with your lawyer; however, we will not say these words for you.
- Approach clients outside of family court. We are open to you approaching us in public, but we will never initiate contact in order to maintain your confidentiality.
I understand the information above and agree to work with the Family Court Support Program within these terms. By selecting yes and providing my name below, I have accepted these terms. *

Yes No
Name *

First Name Last Name
Please Note:

It is our policy that to access services, both the client and the worker must consent to working together within terms outlined. You are welcome to engage in further discussion with your worker during your first appointment if you have further questions or concerns.

Client Confidentiality Agreement
I understand that all services are confidential within the agency and that the release of any information outside of the Sexual Assault Support Centre of Waterloo Region (SASC) regarding my involvement may occur only upon my written consent. I also understand that the exceptions to this include:
- Suspected child abuse or neglect. SASC staff and volunteers are required by law to inform Family and Children Services (F&CS) of any suspected child at risk. This includes a child that has witnessed a parent or caregiver being harmed.
- When a client indicates that she is a danger to herself or others
- In cases of court orders and/or search warrants
In addition, I agree to maintain confidentiality of any client or volunteer that I may encounter at SASC, including not disclosing that I have seen them.
I have read, or have had read to me, the information above and agree to work with the staff at the Sexual Assault Support Centre of Waterloo Region within these terms. By selecting yes and providing my name below, I have accepted these terms. *

Yes No
Name *

First Name Last Name
Please Note:

It is our policy that to access services, both the client and the worker must consent to working together within terms outlined. You are welcome to engage in further discussion with your worker during your first appointment if you have further questions or concerns.
That concludes the Family Court Support Program Referral & Intake Form. Please press the Submit button below.
Should be Empty:

Referral and Intake Form

If you are a worker referring a client:

Referral and Intake Form

Ex Partner Information:

Children:

Involvement With Legal System:

Family Court Support Program Terms & Conditions

Please Note:

Client Confidentiality Agreement

Please Note:

That concludes the Family Court Support Program Referral & Intake Form. Please press the Submit button below.