First and Last Name of Military Member
Military Service # (Last three digits of Service #)
Date of Birth
Rank
Job Title
Section
Primary Language
Is this an Imposed Restriction (IR) Posting? YesNo
Address
City/Town
Postal Code
Email (home)
Email (work)
Telephone (home)
Telephone (cell)
Telephone (work)
First and Last Name of Spouse/Partner
Email (Spouse/Partner)
Spouse/Partner's Primary Language
Children's Names and Dates of Birth
Did you receive a North Bay MFRC Welcome Package? YesNo
Would you like specific information in regards to: Personal Enrichment ProgramSpousal/Teen EmploymentChildren and Youth ProgramsLittle Wings Childcare CentreTeen CentreVeteran Family ProgramVolunteer ServicesSecond Language TrainingDeployment SupportPrevention, Support & InterventionParent SupportFamily Liaison/Social Worker
Would you, your spouse, or any family members like to be contacted by a member of the MFRC team to answer any questions you may have and personally welcome you to the community? YesNo
If yes, please check the box for preferred communication: Video Chat (Zoom)Phone CallEmail
The Military Family Services Program (MFSP) and all 32 Military Family Resource Centres (MFRCs) have adopted a new database system called “Penelope”. This database system tracks the number of families we support and the programs and services we are currently offering. Penelope tracks statistics in turn these statistics are shared with MFSP who determine our funding. Penelope statistics also help us plan future programming to better support our community while remaining accountable for the services we provide.
Please note that all information entered in the Penelope database or on file is secure and confidential.
We require your permission to enter your family’s information into Penelope. Below is the Penelope Privacy Notice and Consent Statement.
Penelope Privacy Notice and Consent Statement
Please read date sign and check the “I Agree” box below.
Thank you for your cooperation.
I Agree
Signature Clear
Maintaining confidentiality of your personal information is an important part of our office policy. Information on this form is used by MFRC personnel in the usual course of business in accordance with the MFRC’s Privacy Policy.