Contact Request

Please complete the Contact Request form below and someone from our Intake Team will get back to you.

Ministry of Community and Social Services Registration Number
Child's Full Name*
First Last
Child's Age*
Contact Parent/Guardian’s Name*
First Last
Contact Parent/Guardian’s email address*
Contact Parent/Guardian’s phone number
Service Region*
If "other" was specified, please add your region below
Choose which Stream of Services and Supports you are inquiring about:*
Multiple selections allowed
- Individual And Consultative Services
- Group Services
- Family Training Services
- Children’s Respite
- Camp Options
Please let us know which specific groups and workshops you are interested in. Any additional comments welcome!