BRC Client Contact Form

I am A:(Obligatorio)

Migrant

Service Provider

Media

US Citizen

Otro

I have a family in Canada who is willing to help

Nombre de pila(Obligatorio)

Apellido(Obligatorio)

Correo electrónico(Obligatorio)

Teléfono

I already tried to make a refugee claim at the Canada border and was sent back to the US

Language for interpretation

My question

Questionaries

Dependents (spouse, children) or accompanying relatives (if applicable)

US Immigration status and history of all prospective migrants

Criminal convictions or charges for any family members

Have any of your family members had criminal convictions or charges?

Previous refugee/asylum claims for client or any family members (if applicable)

Have you or any of your family members previously made a refugee or asylum claim (if applicable)?

Previous entries into Canada (if applicable)

Have you had any previous entries into Canada (if applicable)?

Do you have any relative(s) in Canada who will support you.(if applicable)

Other Details

Fecha de nacimiento

Country of Origin

Current address in the US (Include, name of detention centre if applicable)

Time Zone

Occupation (current or former)

How did you hear about us?

All fluent languages

Interpretation required

Intends to make a refugee claim at Canada Border

Texting might be used to confirm name spelling, and email address etc.). FYI US carrier laws require this, and Dialpad is a US based system.

"Do I have your permission to send you an SMS in a minute so I can verify [the spelling of your name, your email address etc.]? I must let you know about this information first: You may text STOP at any time to stop getting messages from us. You can reply HELP for more information. You will not receive regular text messages from the Canada-US Border Rights Clinic. Message and data rates may apply. We do not share or sell your information to anyone outside our clinic. You can review our privacy policy on our website. Do you consent to receiving a text message now?”

Do you Consent to receive messages

BRC Client Contact Form