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Programs – Learn Registration Form
New Registration Form
Participants Name
*
First
Last
Main Contact Email
*
Address
*
Street Address
Address Line 2
City
Alberta
British Columbia
Manitoba
New Brunswick
Newfoundland and Labrador
Northwest Territories
Nova Scotia
Nunavut
Ontario
Prince Edward Island
Quebec
Saskatchewan
Yukon
Province
Postal Code
Emergency Contact Name
*
First
Last
Emergency Contact Email
*
Emergency Contact Phone
*
Will participant use Access Calgary to come to programs?
Access #
If participant is arriving by Access Calgary, do they need to be handed over?
Primary Support Person Name
First
Last
Primary Support Person Phone
Medical concerns/conditions ((including dietary and other restrictions such as caffeine, sugar, etc.)
What to do to do if one of the concerns is encountered.
Anything that would be helpful to staff while attending community and social events with you? (behavioural challenges, noise or light sensitivities, fears such as heights or loud bangs, stairs or escalators, etc., anxiety or other social phobias)?
Do you use a walker, wheel chair or other assistive technology that we should know about?
Choose Program
Monday Media & Advertising (No Program Fee)
Monday Indigenous Arts & Culture
Wednesday Gentle Yoga (12 week program)
Wednesday Spring Evening Cooking
Wednesday Pizza Night (12 week program)
Thursday Arts & Crafts
Thursday Focus 4 Health
Thursday ASL (12 week program)
Saturday Bowling (12 week program)
Payments
12 week program Registration
Price:
$ 110.00 CAD
Quantity:
$110.00/program *Excludes Arts & Crafts, Cooking, Focus 4 Health, Desserts & Indigenous Art
Arts & Crafts Registration
Price:
$ 135.00 CAD
Quantity:
$135.00/program (includes supplies)
Focus 4 Health Registration
Price:
$ 90.00 CAD
Quantity:
$90.00/program
Cooking & Desserts
Price:
$ 75.00 CAD
Quantity:
$75/program
Indigenous Art
Price:
$ 75.00 CAD
Quantity:
$75/program
Miscellaneous
Price:
$ 1.00 CAD
Quantity:
For Miscellaneous charges
Total
$ 0.00 CAD
Credit Card
American Express
Discover
MasterCard
Visa
Supported Credit Cards: American Express, Discover, MasterCard, Visa
Card Number
Month
01
02
03
04
05
06
07
08
09
10
11
12
Year
2023
2024
2025
2026
2027
2028
2029
2030
2031
2032
2033
2034
2035
2036
2037
2038
2039
2040
2041
2042
Expiration Date
Security Code
Cardholder Name
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