Headwaters Health Care Centre's (Headwaters) Clinical Priority Plan Survey

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Your local hospital needs your input as it develops its programs and services for the future

Headwaters Health Care Centre is looking to community members and partners to provide input as it plans the hospital’s clinical programs and services for the next five years.  

With fast-growing Dufferin-Caledon populations that are estimated to hit a combined 266,000 by 2041, we recognize the health of our community is a priority. We need to ensure we are prepared for the future.  

A confidential survey is open from September 27, 2022, to October 13, 2022.

The survey can be found on the hospital’s website:  headwatershealth.ca  

“We look forward to learning more about what is working well and where there are areas for improvement at our local community hospital,” said Annette Jones, Vice President, Patient Experience and Health Integration and Chief Nursing Executive. “Feedback is being gathered from our community, staff, physicians and volunteers and partners to help us create a ‘focus’ of work for the next five years as part of a formal Clinical Priorities Plan.”  

All responses are anonymous and confidential. The survey is being managed by Optimus SBR; a third-party consulting firm Headwaters has hired to help develop their clinical plan. Random prizes will be drawn from submitted entries. If you chose to provide your contact information (name and email address only), your name will be entered into the random draw. This information will not be kept on file for any purpose other than for the survey prize draw. Winners will be notified via email of prize award and options for delivery after the survey is closed.  

You can find out more at headwatershealth.ca

Headwaters Health Care Centre Survey Promotional Graphic

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Personal information on this form is collected under the authority of the Municipal Freedom of Information and Protection of Privacy Act and will be used for the purposes of collecting payment and registering players for the Ping Pong for Adults program. Questions about this collection should be directed to the Clerk’s Office: ClerksOffice@townofmono.com, 347209 Mono Centre Road, Mono ON L9W 6S3, 519.941.3599.

Registration Form:

Please fill out the form below. Registration fees are non-refundable. * indicates a required field.

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Please fill out the form below. Registration fees are non-refundable. * indicates a required field.

Complete Registration and Pay

To continue, you must first select at least one session and fill out all the required fields.

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  • Rental fee is non-refundable.
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  • ONE  TABLE and TWO CHAIRS will be provided per rental fee. Table and chairs are the property of the Organizer and damage to them must be paid for by the Vendor.
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  • Pets, alcoholic beverages, and smoking are prohibited.
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  • The Town of Mono is not responsible for accidents or injuries during the set-up of the event, the event, or tearing down the event. This includes people assisting Vendors.
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  • The Town of Mono is not responsible for lost or stolen merchandise and/or money.
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  • Vendors will have access to set-up their table on Friday, November 8 from 1 p.m. to 4 p.m. and Saturday, November 9 from 8:30 a.m. to 9:30 a.m. Elevator is available for use.
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  • Burning candles is prohibited.
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  • Vendors are requested to remain set-up until the close of the event at 4:00 p.m. All items that were brought by the Vendor must be removed by the Vendor.
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  • The Vendor will not sublet or rent out their assigned space at any time.
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  • The Organizer is permitted to take photographs of the booths, Vendors and the event. The Organizer is permitted to use these photographs for advertisement or promotion purposes.
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  • Nothing can be glued, taped, or tacked to the walls.
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  • Electricity is available but limited. Please let us know in advance if you will need it. Extension cords will not be provided. Cords must be secured to the floors with tape.
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  • Limited internet available. Internet is not guaranteed at all times.
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  • Vendors are responsible for their own cashbox and table covering.
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  • Payment will secure your table at the event.

Security Check

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Submit Your Suggestions

Contact Information

How would you like to be contacted if your naming suggestion is selected?

Naming Suggestions

You may provide ONE suggestion per park.

Fieldstone Parkette (Current Name)

Find out more about Fieldstone Parkette.

Fieldstone Parkette

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Thank you! Your naming suggestions have been received!

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Registration Form:

Please fill out the form below. Registration fees are non-refundable. * indicates a required field.

Register: Individual Player/Doubles

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Registration Form:

Please fill out the form below. Registration fees are non-refundable. * indicates a required field.

Registration is full.

Registration Form:

Please fill out the form below. Registration fees are non-refundable. * indicates a required field.

Registration is full.

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Registration is non-refundable.

Personal information on this form is collected under the authority of the Municipal Freedom of Information and Protection of Privacy Act and will be used for the purposes of accepting payments and registering attendees for the Town of Mono's Home Alone Safety Course for Kids. Questions about this collection should be directed to the Clerk’s Office: ClerksOffice@townofmono.com, 347209 Mono Centre Road, Mono ON L9W 6S3, 519.941.3599.

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Child's Information:

Release of Liability

Personal information on this form is collected under the authority of the Municipal Freedom of Information and Protection of Privacy Act and will be used for the purposes of collecting Halloween colouring submissions and addresses for the 2021 Halloween Treat Bag delivery. Questions about this collection should be directed to the Clerk’s Office: ClerksOffice@townofmono.com, 347209 Mono Centre Road, Mono ON L9W 6S3, 519.941.3599.

Completed Colouring Sheets & Halloween Costume Pictures

You must upload at least one colouring sheet per child. You are also welcome to upload any pictures of your child /children wearing their costumes. Only upload these photos if you would like them shared on the Town's website and social media.

File Upload *

You must upload a file. If you are unable to submit the form, please check to make sure your file has uploaded.

Security Check *

You must check the box to indicate you are not a robot. This security check is here to prevent spam and abuse of our system.

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Thank you! Your colouring sheet and information have been received! Our ghoulish helps will be delivering the treat bag to the address provided on October 29, 2021.
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Personal information on this form is collected under the authority of the Municipal Freedom of Information and Protection of Privacy Act and will be used for the purposes of collecting addresses to judge for the Halloween Home Decorating Contest. Questions about this collection should be directed to the Clerk’s Office: ClerksOffice@townofmono.com, 347209 Mono Centre Road, Mono ON L9W 6S3, 519.941.3599.

Contact Information

Please enter your phone number or email where we can reach you if you are chosen to be the winner.

Please enter an alternate phone number if we cannot reach you at your preferred method of contact.

Can We Share Images of Your Home? 

Let us know if we may share an image of your home on our website and social media.

At least one judge will come and take a picture of your house (even if you indicated you do not want it shared on the website and social media). The image will be circulated to the other judges who will vote on this year's home decorations

Security Check *

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Thank you! Your entry into our home decorating contest has been received! At least one of our judges will come by on October 27, 2021.
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Registration

Part 1

Select the Wreath and Wine Workshops you are registering for today.

Evergreen Wreath

Session 1 of 1
Cost: 
85.00

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$

Part 2

After you have selected the Wreath and Wine Workshops, we will ask you for the attendee's contact information and age (all attendees must be at least 19 years old).

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PARENT / GUARDIAN INFORMATION

Parent / Guardian Registrant's Information

Please enter the name of parent/guardian for the registration. This will be the name you will use to reference at the door.

Additional Parent / Guardians

CHILD / CHILDREN REGISTRATION

Children's Names

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Take the Survey

Documents

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How Many Participants Are You Registering?

Parent Information

Please enter the email where we should contact you regarding updates to the soccer program. Your email will only be used for contacting you about soccer.

Select One  

 

 

This field is required if you indicated that you would like to be a coach or assistant coach. Commas are not accepted in this field.

First Player: Select the Age Group *

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Participant Information *
 
Gender *

We ask for gender, because it is useful to us when we are organizing the teams.






Player History *

To help us organize the teams, we would like to know if your child has previous soccer experience.




Please provide the name(s) of players who you would like to be on the same team as your child. Do NOT use commas to separate the names. Use "and".
Please Note: we may not be able to accommodate every request.

Second Player: Select the Age Group *

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Second Participant's Information *
  Gender *




Player History *


Please provide the name(s) of players who you would like to be on the same team as your child.
Please Note: we may not be able to accommodate every request. Do not use commas in the field. Separate more than one name with "And."

Third Player: Select the Age Group *

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Third Participant's Information *
 
Gender *




Player History *


Please provide the name(s) of players who you would like to be on the same team as your child.
Please Note: we may not be able to accommodate every request. Commas cannot be used in the field.

Fourth Player: Select the Age Group *

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Fourth Participant's Information *
 
Gender *




Player History *


Please provide the name(s) of players who you would like to be on the same team as your child.
Please Note: we may not be able to accommodate every request. Commas cannot be used in the field.

Complete Registration & Pay*
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Date Posted: 
October 14, 2022