KMC Client Registration Form

Welcome to the Kababayan Multicultural Centre (KMC) client registration form. By completing this form, you will be connected with one of our counsellors, who will provide timely and personalized support to meet your needs.

All of our services are free of charge, made possible through funding from Immigration, Refugees and Citizenship Canada (IRCC) and other government partners. As part of our funding requirements, we collect specific information from our clients to ensure our programs meet your needs and to report on our services.

Please be assured that KMC is fully committed to protecting your privacy and maintaining the confidentiality of all personal information provided through this secured form. KMC adheres to all Canadian privacy laws, including the Personal Information Protection and Electronic Documents Act (PIPEDA). For more details, you can review KMC's Consent and Confidentiality Statement at the end of this page.

Your Personal Details

First Name(Required)

Middle Name

Last Name(Required)

Date of Birth(Required)

Marital Status

Sex at Birth(Required)

Gender

Email Address(Required)

Phone Number(Required)

Level of Education

Native Language(Required)

Other Spoken Languages (if applicable)

Current Residential Address

Address(Required)

Apt/Unit #

City

Province(Required)

Postal Code(Required)

Immigration Related Information

Status in Canada(Required)

UCI (Unique Client Identifier)(Required)

UCI (Unique Client Identifier)

Note: UCI (Unique Client Identifier) is optional but encouraged—if not provided, our counsellor will contact you to collect this information before receiving services.

How Did You Hear About Us(Required)

Country of Birth(Required)

Date of Arrival(Required)

Immigration Document: Optional but encouraged—if not provided, our counsellors must verify your information using one of the following immigration documents before services can be delivered:

Permanent Resident Card
A confirmation of Permanent Residence (COPR) letter/document
A Notice of Decision letter

Immigration Document

Drop files here or

Accepted file types: pdf, docx, doc, jpg, gif, tiff, Max. file size: 10 MB, Max. files: 1.

Services

Which type of services are you interested in:(Required)

KMC is committed to protecting your privacy and ensuring that your personal information is collected, used, and disclosed in a secure and respectful manner. KMC adheres to the Government of Canada’s Privacy Act, the Province of Ontario’s Freedom of Information and Protection of Privacy Act, R.S.O. 1990, c. F.31 and the Personal Information Protection and Electronic Documents Act (PIPEDA) to ensure that your personal information is protected and secured.

Please find more details about KMC's commitment to protecting your personal information in our Declaration and Consent form.

By submitting your registration form and providing your initials or signature in the designated box, you confirm your agreement to the terms outlined in this consent form regarding the use of your personal information.

Please either enter you initials here OR Sign in next box

Signature(Required)

Captcha