Forms

Displaying 1 - 25 of 141
November 5, 2021

<p>This form is to help you apply to become a volunteer for continuing care's volunteer services program. Fill it out and return it to the volunteer coordinator. If you are under the age of 18, parent or guardian consent will... more

October 29, 2021

<p>This form is to be filled out by a parent or guardian. It grants consent for a minor to apply to volunteer for continuing care.</p>

October 29, 2021

<p>This survey is to gather feedback from volunteers for the continuing care team. It helps to improve the program for future volunteers and residents.</p>

October 29, 2021

<p>This survey is to help provide improve the volunteer program for continuing care. Return the completed survey by email, mail or in-person.</p>

October 25, 2021

<p>This is the RSV immunoprophylaxis program application form. It is to be filled out to enrol a high risk child.</p>

October 15, 2021

<p>This form is used to get a health approval and inspection for a new facility, location or ownership of a business. This includes beverage production and manufacturing, a care facility, a personal service, and bed and breakfast... more

September 24, 2021

<p>This form is to access volunteer shopper services for a resident of a continuing care facility. Fill out this form and return it to the care coordinator.</p>

August 26, 2021

<p>This form is to consent to the disclosure of health information to another person. It should be filled out and submitted to a privacy officer.</p>

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August 26, 2021

<p>This form is to declare status as a substitute decision maker for another person. It should be filled out to request a Proof of Vaccination Credential.</p>

August 18, 2021

<p>Use this form to get help to cover costs for medical travel.</p>

August 13, 2021

<p>Use this order form for the From the Ground Up fundraiser for daycares.</p>

August 13, 2021

<p>This is the order form for the From the Ground Up fundraiser for schools.</p>

August 2, 2021

<p>This form is for Yukon families or individuals to apply to be a caregiver to a Yukon child.</p>

July 28, 2021

<p>Parents or guardians complete this form to consent or refuse consent of their child’s enrolment in Yukon Children's Dental Program.</p>

July 14, 2021

<p>This form is to apply for the youth roots positive youth development grant. Submit your completed form to the health promotion team in-person, by email, mail or fax.</p>

July 1, 2021

<p>Yukon seniors who own or rent their homes can apply to the Pioneer Utility Grant (PUG) to get help with paying for home heating costs on their primary residence.</p>

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July 1, 2021

<p>Yukon seniors who own or rent their homes can apply to the Pioneer Utility Grant (PUG) to get help with paying for home heating costs on their primary residence. For renters, this certificate is completed by the landlord and... more

May 18, 2021

<p>This form can allow a patient to request medical assistance in dying. It should be given to a doctor or nurse practitioner.</p>

April 30, 2021

<p>Health care providers use this form to refer your patients to the Chronic Conditions Support Program. These include: Your Health! Your Way!; Diabetes Wellness Series; supervised exercise; and Pulmonary Rehabilitation Program.... more

March 30, 2021

<p>Use this template to develop an operational plan for your tourism operatation to address public health measures during the COVID-19 recovery in Yukon.</p>

February 26, 2021

<p>This form is for someone from your&nbsp;health-care team to fill out. It's needed to enter a continuing care facility or community day program in Yukon.</p>

February 8, 2021

<p>Complete this form if you have symptoms of COVID-19 and want to get tested at the COVID Testing and Assessment Centre in Whitehorse. After you fill out the form email it to <a style="box-sizing: border-box; background-... more

January 28, 2021

Download and complete this form to apply to be certified as a child care worker.

November 25, 2020

<p><span style="font-size: 16px;">This form is for someone from your&nbsp;health-care team to fill out.</span> It's needed to enter hospice in a continuing care facility in Yukon.</p>

September 27, 2020

This is the form to fill out if you are a health professional reporting an exposure incident for blood and body fluids.