LIT Intake Form

By checking the "I agree" box below, you agree and acknowledge that 1) your application will not be signed in the sense of a traditional paper document, 2) by signing in this alternate manner, you authorize your electronic signature to be valid and binding upon you to the same force and effect as a handwritten signature, and 3) you may still be required to provide a traditional signature at a later date.

The personal information requested on this form is being collected under the authority Section 33(c) of the Freedom of Information and Protection of Privacy (FOIP) Act. The information collected will be used for the purpose of administering program registration and membership management and may be communicated to relevant City business units and Alberta Health Services.

If you have any questions about the collection or use of your personal information, contact the City of Beaumont’s FOIP Coordinator at 5600-49th Street, Beaumont, Alberta, T4X 1A1 or 780-929-8782.