Crisis Care Facility Exemption Request

Purpose of the Exemption Process

Under Section 17 of the Town of Ajax Crisis Care Facility By-law, the Director may grant exemptions from specific requirements if satisfied that the exemption maintains the general intent and purpose of the by-law. Use this form to request relief from one or more sections, providing clear justification for your request. The Director may impose conditions on any exemption granted.

Crisis Care Facility Exemption Request Form

Specify By-law Section Number(s)(Required)

e.g. 4.2(a); 5.1.3; Schedule A, s.2(b)

Reasoning for the Exemption Request(Required)

Provide detailed justification. Explain why the exeption is needed, how you will maintain health, safety, and well-being, and any proposed conditions or mitigations.

Applicant Contact

Name(Required)

First Last

Phone Number(Required)

Email Address(Required)

Organization/C.C.F. Operator(Required)

Signature(Required)

Personal Information Notice

Personal information contained on this form is collected under the authority of the Municipal Act and will be used for the consideration and/or approval of a Crisis Care Facility Exemption Request. Questions about this collection should be directed to the Records & Freedom of Information Coordinator at 65 Harwood Avenue South, Ajax, Ontario, L1S 2H9. (905) 619-2529 ext. 3343.