Tribunals Ontario Animal Care Review Board
Name of Appellant Date (yyyy/mm/dd) Time a.m. p.m.
Describe in detail the reason for this adjournment request. Attach additional pages if you require more space.
*Provide three dates within the next 20 days that all parties are available to attend. 1. Date (yyyy/mm/dd) 2. Date (yyyy/mm/dd) 3. Date (yyyy/mm/dd)
Name Signature Date (yyyy/mm/dd)
The Animal Care Review Board (ACRB) collects the personal information requested on this form under section 38 of the Provincial Animal Welfare Services Act and section 9(5) of Ontario Regulation 443/19 for the purpose of conducting an appeal proceeding before the ACRB. All information, including sensitive personal and financial information, submitted as part of a proceeding may become public in an open hearing and may be contained in decisions, orders, and case files, unless an order to restrict access is made. Any questions about the collection of information may be directed to the ACRB at ACRB.registrar@ontario.ca.
If you have any questions, please contact Animal Care Review Board 15 Grosvenor St, Ground Fl Toronto ON M7A 2G6 Telephone: 416-327-0111 / 1-888-777-3616 Teletypewriter (TTY): 1-800-855-0511 Fax: 416-314-4270 / 1-800-720-5292 Website: tribunalsontario.ca/acrb Email: ACRB.registrar@ontario.ca
0428E (2021/01) © Queen’s Printer for Ontario, 2021
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