ASL Interpretation Request Form

Inclusion and Accessibility for Recreation Programs

Required fields are marked with an asterisk (*)

ASL Interpretation Request Form

This form is to assist individuals to request American Sign Language Interpreter for programs that are run by the Halifax Regional Municipality (HRM). Please request an interpreter at least 1 month before the program starts. The availability of interpreters depends on our vendor.

In accordance with Section 485 of the Municipal Government Act (MGA), any personal information collected in this form will only be used by municipal staff and, if necessary, individuals and/or organizations under service contract with the Municipality for purposes relating to providing American Sign Language (ASL) services.

If you have any questions about the collection and use of your personal information, please call 311 or email contactus@311.halifax.ca.

ASL Interpretation

Name of the person registered for the program: *

Name of the person filling out the form (if different from above):

Please provide one method for contacting you (email or text) *

Who are you making the request for?

Myself

Dependent/Child

Spouse/Partner

Parent

Other

Select all that apply.

Please provide information about the program

Name of the Program *

Location of the Program *

Start Date of the Program *

If you (or the person requesting interpretation) are not registered for the program, you will need to do so before an interpreter is booked. If you are unsure about how to register, please review the following videos. (Program Registration | Recreation Activities | myREC | Halifax. The interpretation requests are currently only available for HRM operated programs (programs with a *) (Rec Centres | Recreation | Halifax)

We are hoping to gather information about your experience with using an interpreter in Halifax Regional Municipalities recreation programs. Would we be able to contact you via email to get your feedback?

Yes

Email (if different from above)