Seasonal Campsite Application contains three forms which need to be presented to the public as one package, not separate applications. Seasonal Campsite Application, Accessible Seasonal Campsite Physician Certificate and Seasonal Campsite Application Credit Card Payment Form are publicly posted together under "Seasonal Campsite Application".
The form an Appellant is required to complete to advise the Board that they want the Board to consider an Exemption from the Ignition Interlock Program for the Licence Suspension Appeal Board (LSAB)
The form is used to provide legal information to applicants of the Manitoba Hepatitis C Assistance Program.  This form is completed by the applicant and a witness known to the applicant.  This form is processed by Manitoba Health, Seniors & Active Living.

Category:Health

This application is used to request the transfer of an agricultural lease or permit to an immediate family member, and/or to request the addition of the name of an immediate family member to an agricultural lease or permit. 

If you would like to complete this application form, please contact: 

Manitoba Agriculture and Resource DevelopmentAgricultural Crown LandsPO Box 128636 Armitage AvenueMinnedosa MB R0J 1E0Office: 204-867-6550Fax: 204-867-6578Email: agcrownlands@gov.mb.ca 

Department/Crown:Agriculture

This form is to be completed when surrendering a lease or permit on agricultural Crown lands or when requesting a name deletion. To obtain the form, contact:

Manitoba Agriculture and Resource DevelopmentAgricultural Crown LandsPO Box 128636 Armitage AvenueMinnedosa MB R0J 1E0Office: 204-867-6550Fax: 204-867-6578Email: agcrownlands@gov.mb.ca

Department/Crown:Agriculture

This policy is intended for use by Health Authorities to guide their process for purchasing, leasing or otherwise acquiring real property, or an interest in real property.

Last updated:  July 11, 2023

   
Department/Crown:Health

This form is used by Manitoba Health, Seniors and Active Living (the department) staff during a site visit to the addictions agencies which are supported in whole or in part by grants from the department. The form is completed by staff during the visit and outcomes reported to the Executive Director responsible.

This form is applicable to­­­­­­­­­­­ all Manitoba addictions agencies which receive grant funding through continuing service agreements with the department; agreement to submit to site visits by department staff is a condition of the agreements. The form is not public-facing.

This form will be processed by the department of Health, Seniors and Active Living.

Department/Crown:Health
Category:Health

This form is designed to provide detailed reporting from Manitoba addictions treatment agencies on the patient population entering their facility. Indicators include intake, referral point, income status, Indigenous status, geographic origin and primary and secondary substances.

This form is applicable to the Manitoba addictions agency supported in full or in part by grants from Manitoba Health, Seniors and Active Living. Requirements to provide this report and others are detailed in the continuing service agreements with the agencies.

This form is processed by the Department of Health, Seniors and Active Living.

Department/Crown:Health
Category:Health

This form is completed by Manitoba addictions agencies to provide detailed financial forecasting and quarterly reporting of their budget and expenditures.

This form is applicable to­­­­­­­­­­­ the Manitoba addictions agencies funded in whole or in part by grants from Manitoba Health, through continuing service agreements (service purchase agreements); this financial reporting is required as a condition of the agreements.

This form is processed by Manitoba Health, Seniors and Active Living.
Department/Crown:Health
Category:Health

This form is used to track the movement of patients in personal care homes, whether through the admission of patients into personal care homes, the transfer of patients between personal care homes and the discharge of patients from personal care homes.  This form is applicable to Manitoba Health, Seniors and Active Living, the regional health authorities and personal care home facilities.  The form is filled out by staff at the personal care homes and processed by Manitoba Health, Seniors and Active Living.

Department/Crown:Health

This form is intended to submit admission/discharge information by Provincial and Federal jail facilities, Manitoba Development Centre and Selkirk Mental Health Centre to Manitoba Health to register or cancel provincial health coverage.

This form is for use only by staff of Registration and Client Services and Provincial/Federal Correctional, Manitoba Development Centre and Selkirk Mental Health Centre.

This form is processed by Manitoba Health, Seniors and Active Living.

Department/Crown:Health
Category:Health
This form is the template of an adoption placement agreement prescribed by regulation made under The Adoption Act.  This agreement outlines the terms and conditions of the placement of a child in the home of a prospective adoptive parent, as agreed by the child and family services agency. 
Department/Crown:Families
Category:Families

Adoption Services (Chapter 6) describes provincial standards for adoption and post-adoption services provided under The Adoption Act.  The documents outline all aspects of adoption, placement, post placement and repatriation services, including procedures and requirements for applicants seeking to adopt a child in Manitoba.

Department/Crown:Families
Category:Families
This form is used for obtaining permission and collecting relevant client immunization history before administering vaccine/s to an adult. This form is applicable to physicians, nurses, and other health professionals providing immunization services. This form is processed by Manitoba Health, Seniors and Active Living.
Department/Crown:Health
Category:Health
This form aids in remembering vaccines administered to adults. This form is applicable to adult recipients of vaccines. This form is NOT processed by Manitoba Health, Seniors and Active Living, and is for the sole use of the client.
Department/Crown:Health
Category:Health

The purpose of this document is to provide information on the Advanced Access training program. This document is applicable to­­­­­­­­­­­ primary care clinics considering taking the training. Manitoba Health, Seniors and Active Living owns and maintains this document.

Department/Crown:Health
Category:Health

This form is an application for currently licenced aeromedical attendant and aeromedical ambulance pilot personnel to renew there air emergency medical response licence. This form is applicable to licensed aeromedical attendant and aeromedical ambulance pilot personnel. This form is processed by Manitoba Health, Seniors and Active Living.

Department/Crown:Health

This form is an application to obtain an aeromedical ambulance pilot air emergency medical response licence in the province of Manitoba. This form is applicable to qualified individuals seeking the credential of aeromedical pilot. This form is processed by Manitoba Health, Seniors and Active Living.

Department/Crown:Health

This form is an application for currently licenced aeromedical ambulance pilot first officer licence to upgrade to an aeromedical ambulance pilot captain air emergency medical response licence. This form is applicable to licensed aeromedical ambulance pilot first officers. This form is processed by Manitoba Health, Seniors and Active Living.

Department/Crown:Health
This form is used to confirm that a person was served court documents. This is a statutory regulation and is embedded in The Child and Family Services Regulation. It  is available at your local CFS agency.
Department/Crown:Families
Category:Families
This Affidavit of Service is a signed written record of the verbal testimony made by a process server to the Commissioner for Oaths in and for the Province of Manitoba that details the time, date, and identity of the person served with the Notice to Birth Father. 
Department/Crown:Families
Category:Families
This guide provides detailed instructions and information on what to do and who to call to help with flood recovery and restore a property to a healthy and safe condition. This guide is applicable to homes, businesses and building operators. Health, Seniors and Active Living provide the guide.
Department/Crown:Health
Category:Health
Standard contract template for engineering services contracts. Included: Service Provider (Non-Engineering) Contract Agreement - Fee Based, Service Provider (Non-Engineering) Contract Agreement - Lump Sum, Engineering Services Contract Agreement - Fee Based, and Engineering Services Contract Agreement - Lump Sum.
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