Lynwood Charlton Centre
526 Upper Paradise Rd
Hamilton  Ontario  L9C 5E3


Phone: (905) 389-1361,
Fax: (905) 389-8765
Child/Youth Referral
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Parental Consent
I agree that by submitting this form I give my consent for the ASN program to contact me for further information. I agree that the information outlined in this form can be used for the purpose of a program or service referral for my child. I understand that I can withdraw this consent at any time by writing a letter to the ASN program.
Child's Consent
I agree that by submitting this form I give my consent for the ASN program to contact me for further information. I agree that the information outlined in this form can be used for the purpose of a program or service referral. I understand that I can withdraw this consent at any time by writing a letter to the ASN program.
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