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2012 family violence shadow

MARC/PAR REFERRAL FORM

Please provide the following information if you have been ordered by the courts to attend the MARC / PAR Program. Registration is to be completed within 48 hours of your court order.

If you would prefer to download the form and fill it out by hand, it is available to download below. You may fax the completed form to the attention of Family Violence Counselling Program at 519-421-0123.

pdfMARC/PAR Referral Form 


Contact Information

Please include street name and number, apartment, P.O. Box, R.R.#



Victim or Partner Information


Description of Incident


Please click the NEXT button to provide your consent for the information you've provided to be collected and shared with the Family Violence Counselling Program, the Crown Attorney's Office and the Court Office.