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Home Town Hall Governance & Accountability By-law Forms & Applications

Crisis Care Facility Licence

Crisis Care Facility (C.C.F.) Licence Application Form

Facility Information

Business Address(Required)

Property Information

Property Owner Name(Required)
Address of Crisis Care Facility(Required)
Is the property leased or owned?(Required)
Property Owner's Consent Submitted?(Required)

Applicant Information

Name of C.C.F. Applicant(Required)

Local Contact (available within 1 hour)

Name of Local Contact(Required)

Required Document Uploads

Max. file size: 1 MB.
Signed authorization from all legal owners of the property where the C.C.F. is/will be located, confirming awareness, consent, and authorization for the intended Crisis Care Facility use. If leased, include lease language permitting the C.C.F. use. Suggested file name: Owner_Authorization_CCF.pdf
Max. file size: 1 MB.
A consolidated plan describing how the operator will comply with Town by-laws and applicable law and engage/mitigate impacts in the surrounding community, per the by-law. CPTED assessment: lighting, natural surveillance, access control, video surveillance, landscaping. Community engagement strategy: communication channels, meetings cadence, issue resolution steps. Security program (24/7): on-site and mobile coverage; incident response on the property and within the surrounding 500 m radius. Lot maintenance plan: bin locations, waste storage areas, service frequency; litter abatement on-site and within the surrounding 500 m radius. Designated outdoor smoking area compliance (Durham Region Smoking & Vaping By-law; Smoke-Free Ontario Act). Parking plan: staff/volunteers/suppliers/visitors; on-street/on-site restrictions; accessible parking. Donation management plan: proactive measures to limit/manage unsolicited donations to patrons. Code of Conduct: summary of expectations, enforcement approach, and provision to occupants. Suggested file name: Operational_Plan_CCF.pdf
Max. file size: 1 MB.
Upload the Floor Plan showing the minimum details specified in the by-law. All exits, windows, all rooms with labels indicating sleeping quarters, and all common areas. Suggested file name: Floor_Plan_CCF.pdf
Max. file size: 1 MB.
Upload the Site Plan showing the minimum details specified in the by-law. Location/number of parking spaces, garbage/waste storage areas, designated smoking areas, enclosures, accessory buildings, and fences. Suggested file name: Site_Plan_CCF.pdf
Max. file size: 1 MB.
Provide your report template and a signed statement committing to provide occupancy reports as required by the Manager. Template fields: number of staff, number of occupants, and remaining available spaces. Include reporting cadence (daily/weekly), responsible contact person, and submission method. Suggested file name: Occupancy_Report_Template.pdf
Max. file size: 1 MB.
Insurance certificate specific to C.C.F. use with a minimum $2,000,000 liability per occurrence, naming the Town of Ajax as additional insured, including endorsement for 15 days’ notice of cancellation/material variation. Suggested file name: Insurance_Certificate_CCF.pdf
Max. file size: 1 MB.
Upload a current Criminal Record Check for the Applicant. Note: the Manager may refuse issuance where certain convictions exist (Parts V, VIII, IX of the Criminal Code without pardon), and may consider other convictions at discretion. Suggested file name: Criminal_Record_Check_Applicant.pdf
Applicant Acknowledgements & Declaration(Required)
Clear Signature