Online Forms

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5. COVID-19 Teen Supports
   The Youth Centre may be closed, but we're still here for you! Please check off any of the services you would be interested in!
7. We're here for you!
   This is a tough time for everyone and we miss getting together at the Youth Centre, but we're still here to help!
   Please fill out your info so we can follow up and please check off any of the services you might be interested in! We'll get in touch with more information.
9. SIGN UP FOR ANY OF THESE SERVICES BELOW!
11. Christmas Care Packages
    If you'd like a Christmas package filled with activities, resources, and maybe even a gift, delivered right to your door, we've got you!
12. Online Youth Centre Programming
    Do you miss your Youth Centre friends? We do too! Let's get together virtually!
14. Check Ins
    Let's talk! If you want to connect with a phone call or through Facebook, we're here to chat, offer resources, and help.
15. Self-Care Packages
    If you're running low on personal care items or food, we can help with personalized care packages that we'll bring to you.
17. First Name
18. Last Name
20. Email Address
21. Phone Number
23. Age
    -- Select One --131415161718
24. Address
26. Please check off all programs that you might be interested in

    1. Christmas Care Package
    2. Online Youth Centre Programming
    3. Check Ins
    4. Self-Care Packages
28. Additional Comments
    If you have other program ideas or other areas of support that would be helpful for you, please let us know!
30. Thank You!
    You will be contacted through email or phone about the services you're interested in.
Leave This Blank:


32. 1. Receive an email copy of this form.
33. Email address

    This field is not part of the form submission.

34. Submit

* indicates a required field