Go!
DONATE
Home
About Us
Programs
Services
Events
Arts&Crafts Gallery
News
Members
Get Involved
Contact
Registration Page
Name
*
First
Last
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 Phone
Access #
Primary Care Giver Email
Primary Support Person Email
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?
Programs/Activities
*
Select All
Saturday Bowling
Gardening
Monday Bowling
Independent Living Life Skills
Photography & Nature
Arts & Crafts
Wednesday Gentle Yoga
Pizza Night
Women's Health & Wellness
Friday Out & About Events
Men's Health & Wellness
Learn to Cook
Programs Registration
*
Price:
$ 70.00 CAD
Quantity:
$70.00/Per program - *Excluding Cooking*
Learn to Cook Registration
Price:
$ 60.00 CAD
Quantity:
Cooking is $60.00
Misc Sales Item
ILRCC will reach out to you after registration to determine which programs you wish to partake in.
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
2022
2023
2024
2025
2026
2027
2028
2029
2030
2031
2032
2033
2034
2035
2036
2037
2038
2039
2040
2041
Expiration Date
Security Code
Cardholder Name
© ILRCC, Charity #12791 4463 RR0001, for website concerns please contact our webmaster.