1. Requirements for Successfully Completing Back on Track
I understand that I must meet the following requirements to successfully complete Back on Track:
1. If you are not sure you can meet this condition, you should complete substance abuse treatment before you register for Back on Track. Contact ConnexOntario at 1-800-565-8603 for help in locating treatment programs in your area.
- I must not use alcohol (including dealcoholized beverages) or drugs within 24 hours of or on any day that I participate in the program.1 I may take medication prescribed by a physician provided it does not impair my ability to participate in the program.2
2. If you are unsure if you can meet this condition, you should consult a doctor before registering.
- I must attend all sessions as scheduled for me and arrive on time for each session.
- I must give 24 hours notice that I am unable to attend by leaving a message directly with the service provider. The only acceptable reasons for missing a session without giving 24 hours notice are serious illness, a death in my immediate family, or severe weather. In case of an emergency I may submit a document (e.g., a doctor’s note, death certificate, or severe local weather report - must be date/time specific) to confirm the reason for my absence. If accepted, I will be required to reschedule the missed component and complete all assignments.
- I must provide accurate information about myself and my remedial requirements.
- I must participate fully in the program activities and demonstrate that I have learned about separating my drinking from my driving.
- I must treat the program staff and other participants with respect. Verbal or physical abuse will not be tolerated.
If I do not meet the program requirements for any reason, I have failed the program. I may re-register for the program again but I must repay the program fee in full. In addition, if any accommodation I require results in extra program costs, I will be responsible for paying these before re-registering. I will be required to retake any scheduled or completed components again and complete all parts of the program to meet the Ministry of Transportation, Ontario (MTO) remedial requirement.
3. Consent to Collect and Release Personal Information
I understand the following:
(Note: Collection of the personal information as described above is for the administration and operation of the Remedial Measures Program. The authority for the collection and use of this information is in accordance with the Highway Traffic Act, R.S.O. 1990, Chapter H. 8, Section 41.1(6.1) and Section 57(6). If you have any questions about the information collected on this form, please contact the Program Advisor, Licensing Services Branch, Driver Improvement office, Ministry of Transportation, 77 Wellesley Street West, Box 671, Toronto, Ontario M3M 1J8, 416-235-1086 or 1-800-303-4993)
- The Centre for Addiction and Mental Health (CAMH), on behalf of MTO will be collecting personal information from me. The local provider will also collect personal information from me on behalf of CAMH.
(Conditions that could result in a medical review include: blackout or loss of consciousness, poor physical co-ordination, a balance problem, visible tremors or shaking, disorientation or confusion, agitated or overly sedated behaviour, and extreme memory problems.)
- This information relates to my identity, program enrolment and participation responses to questions.
- If applicable MTO will receive any recommendations for medical review.
- In case of payment issues, my payment records may be shared with financial institutions.
All personal information that I provide to CAMH and/or the local provider may be shared with MTO through Back on Track's encrypted website, secure email and facsimile transmission, by registered mail or by courier and will be kept as part of my record on an encrypted database. Once I complete the program, only CAMH and MTO will have access to my record unless I give written consent to do otherwise.
CAMH operates Back on Track on behalf of MTO.
4. Authorizations. Please list anyone you wish to give access to your information in this section, including a translator or helper you need. They will be able to schedule appointments on your behalf and communicate with the program staff if necessary. Listing names in this section is your agreement to give them access to your file.
Requests to remove an authorized person must be made in writing.
I also understand the following conditions:
- The program fee is non-refundable.
- If I need a language interpreter, translator, helper or any other special arrangement to participate fully in the program, I am responsible for making the arrangements and paying any associated costs. The translator / helper must be 18 years of age or older. My requirements may be decided by program staff.
- If program staff observe that I have a medical condition that they are concerned could affect my ability to operate a motor vehicle safely, they may recommend a medical review to the Ministry of Transportation. I may be informed if such a recommendation is made.
- I am responsible for any travel costs to attend any program component.
- It may take up to 11 months to complete all parts of the Back on Track program: Assessment, 1 or 2 day workshop and Follow-up.
- I am required to begin participation in the program within 5 years of receipt of my registration confirmation. After 5 years, I will be required to re-register by completing this form and paying the registration fee again.
- I am responsible for scheduling all of my appointments.
- 1. Requirements for Successfully Completing the Back on Track program
- 2. Consequences
- 3. Consent to Collect and Release Personal Information
- 4. Authorizations
- 5. Conditions