Staff Login
Volunteer Login
ESCAPE THIS SITE >>
Search
Open Navigation
Close Navigation
Contact
Home
About
Programs
North Grenville
Crisis Intervention
Family Court Support Program
Internet Child Exploitation (ICE) Program
Mobile Tracking System
Safety Planning
Senior Safety Program
Support Teens at Risk (STAR) Program
Victim Quick Response Program (VQRP)
Volunteer
Resources
Break & Enter
Domestic Violence / Dating Violence
Family Court Support Information
Safety Planning
Seniors / Elder Abuse
Sexual Assault / Abuse
Teenagers
Tragic Circumstances
Trauma
We're Hiring
Contact
Service Provider Referral Form
Police Services Referral Form
Feedback Form
Self-Referral
Self-Referral Form
First Name
*
Last Name
What would you like us to help you with?
*
Information
Someone to talk to
Something to read (sent by mail)
Something to read (sent by email)
Help with referrals
Emotional Support
Basic necessities (food)
Safety planning
See someone at the office
Referral for sexual assault / abuse counseling
Referral to our human trafficking peer support program
Other
If marked "Other" please specify
Are you?
*
0 - 15 years old
16 - 18 years old
18 - 35 years old
36-65 years old
65+
How do we reach you?
Phone Call
Is it safe to leave a message? Is there a preferred time to call?
Text
Address
City
State/Province
Alberta
British Columbia
Manitoba
New Brunswick
Newfoundland and Labrador
Northwest Territories
Nova Scotia
Nunavut
Ontario
Prince Edward Island
Quebec
Saskatchewan
Yukon Territory
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Guam
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Zip/Postal Code
Email Address
If you want resources or information sent to you via email or traditional mail, please let us know what information you are looking for. Please note that any incident does not need to be current and charges do not need to be laid. Individuals struggling with or seeking information about historical events are welcome to reach out as well as support persons for are assisting others who are struggling.
Domestic abuse / assault
Sexual abuse / assault
Assault (physical)
Child Abuse
Stalking & Criminal Harassment
Elder Abuse
Hate Crimes
Homicide
Suicide
Sudden Death
Human Trafficking
Motor Vehicle Accident
Robbery
Theft / Fraud
Fire
Tragic Circumstance
Family Court
Are you?
*
A direct victim / survivor
A family / friend or support person of a victim / survivor
A witness to an event
Looking for general information / interest
Is there anything else you wish to tell us?
Enter the code displayed
*