Common Ground Participant Registration

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* 1. Upcoming Common Ground Dates/Locations

Orillia Wednesday April 1st - April 29th

Barrie Wednesday May 20th - June 17th

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* 2. What Location of Common Ground are you interested in?

Barrie

Orillia

Virtual

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* 3. Participant's Full Name

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* 4. Participant's Date of Birth

Date / Time

Date

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* 5. Caregiver or Youth Contact Information

Name *

Address

City/Town

Email Address *

Phone Number *

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* 6. Common Ground often has our facility dog(s) present. Are you comfortable with dogs?

Yes

No

Unsure

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* 7. Please list any food allergies or dietary restrictions

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* 8. What is your preferred method of contact?

Phone

Email

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* 9. OPTIONAL: Where did you hear about Common Ground?

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* 10. PLEASE NOTE: You will be contacted by a CYACSM Staff member to confirm dates, time and registration closer to our next start date for your location requested.