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
Person's Full Name*
First Last
Person's Age*
Contact Parent/Guardian’/Decision Maker’s Name*
First Last
Contact Parent/Guardian/Decision Maker’s email address*
Contact Parent/Guardian/Decision Maker’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
- Group Services
- Children’s Respite
- Individual And Consultative Services
- Family Training Services
- Camp Options
Please let us know which specific groups and workshops you are interested in. Any additional comments welcome!