Registration Form

Participant Details

Name *

First

Last

Email *

Phone Number *

Enter your phone number

to like you

Do you have access to transportation *

• Yes
• No
• Have some one to drive me
• I need a ride

Would you like to enroll into activities? *

• Weekdays
• Weekends

Do you speak english *

• Yes
• No
• A little
• Would like to learn

Would you like a interpreter

• Yes
• No

Submit

For questions call 519-239-7249