Adapt the “Parents like us” Handbook – Template Request Form

Name

Email address

Province or Territory

City:

Organization or affiliation (if applicable):

I identify as a parent or caregiver supporting a young person struggling with substance use.

Yes

Prefer not to say

Check the box below to accept the conditions for which the information is being collected.

I agree to provide the information requested on this form and I understand that (i) it is being collected for the purpose of responding to my request, (ii) CCSA may follow up with me in the future to gather additional information about this request for analytics purposes, and (iii) any personal information or comments I provide will be protected under the provisions of the CCSA website Privacy Notice.

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Math question 7 + 8 =

Solve this simple math problem and enter the result. E.g. for 1+3, enter 4.

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Adapt the “Parents like us” Handbook – Template Request Form