HOPE Learning Centre Fall Course Registration 2023

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

Address *

Address 2

City/Town *

Province *

Postal Code *

Country *

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

Yes

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

Yes

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* 10. Have you attended Hope Learning Centre groups in the past? Please answer yes or no

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

Peterborough

Lindsay

Haliburton

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