Any Other Community Care Facility / IF DIFFERENT FROM FACILITY / Facility Owner OWNER OF BUILDING /COMPLEX / LICENSEE AMENDMENT Facility / IF THE FACILITY IS PART OF A MALL / /
MedicalCondition
Injury / /
Organization
Vancouver Island Health Authority / Information and Privacy Office / EMAIL SPECIFY PROPOSED SERVICE / FULL MEALS/FOOD SERVICE / provincial government / / /
Position
Manager / address and telephone number / OFFICIAL / Manager Currently / Manager of a Community Care Facility / Board Member / Manager Previously Applied / MANAGER NAME FACILITY MANAGER Information MANAGER MAILING ADDRESS CITY PROV TELEPHONE FAX POSTAL CODE EMAIL Is / Manager of Any / MANAGER / facility Manager / Manager at least 19 Years / /
APPLICATION FOR COMMUNITY CARE FACILITY LICENCE COMPLETE ONE APPLICATION IN FULL FOR EACH FACILITY USING BLOCK PRINTING WHERE POSSIBLE AND COMPLETELY FILLING IN THE APPROPRIATE BOXES The personal information collected