If you would like more information and/or would like support completing this form, please contact hopelc@cmhahkpr.ca or CMHA Reception at 705-748-6711 or 705-328-2704

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* 1. First Name

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* 2. Last Name

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* 3. Birth Date

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* 4. Pronouns

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* 5. Phone Number

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* 6. Email Address

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* 7. Address

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* 8. Do you consent to receiving text message reminders for group?

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* 9. Please indicate where you will be attending group.

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* 10. The following groups are full for this semester. Look for them in future semesters. Anger Management, Challenging Loneliness and Isolation, Living with Depression, Conquering Negative Thoughts, Establishing Boundaries, WRAP, Bowling in Peterborough, Recreation Hybrid Sports, Recreation YMCA Guided Work Out, Recreation Yoga, Crafty Connections Minden, When Grief is Complicated.

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* 11. Please select which course(s) you would like to register for.
Also, please write down selected course for your own reference ex. calendar, notepad, phone calendar etc.

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* 12. I understand that I will not attend groups until contacted by a HOPE staff

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* 13. From the dates listed in the group selection above, please indicate the dates and location in which you will attend your registered groups

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* 14. Other information

Thank you for your interest in the HOPE Learning Centre, and we look forward to connecting with you.

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