Online Registration – HEAL – Hope Exists After Loss Youth Program

Registration FULL for January 29, please fill the form below and click waitlist if you still want January 29
or see below for future intake dates.

Online Registration – HEAL – Hope Exists After Loss Youth Program

Information collected on this authorized form complies with the Privacy Act and Personal Health Information Protection Act. Scarborough Centre for Healthy Communities (SCHC) collects information to assist with program planning, improvement of services, and research. This information is confidential and shall not be used for purposes other than those for which it was collected, nor shall any identifying information be sent externally, except with your expressed consent or as required by law. Answering questions marked optional is voluntary. We encourage you to discuss any questions or concerns you may have with one of our staff.
Occasionally, staff may take photographs of participants in the program. Photos are used internally within the program or externally in displays promoting the agency/program or in the agency newsletter.

* Indicates required field

Please choose one *

Yes consent to pictures of me being taken and displayed No do not consent to pictures of me being taken and displayed

Age *

Date of Birth (MMDDYYYY) *

Today's Date (MMDDYYYY) *

Do you live in Scarborough? *

Yes No

Name *

First

Last

Address *

Line 1

Line 2

City

State

Zip Code

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Home Phone *

Mobile Phone *

Email *

If Not Listed (Please Specify) *

Emergency Contact Name *

First

Last

Phone Number *

Relation *

Allergies *

Food Restrictions (food you do not eat) *

If you have any physical/mental/intellectual/invisible disabilities, is there anything we can do to accommodate you? *

Yes (Please Specify) No

Please Specify *

Are there any other programs that you are interested in? Please list below: *

How did you hear about us? *

Why are you interested in this program? *

Group Dates Sign Up (Max 10 Youths Per Group) *

Friday, January 29 - Friday, March 19 (Click to be Waitlisted) Thursday, April 8 - Thursday, May 27 (10 Spots Left) Friday, April 9 - Friday, May 28 (10 Spots Left) Thursday, June 10 - Thursday, July 29 (10 Spots Left) Friday, June 11 - Friday, July 30 (10 Spots Left) Waitlist (If Spots Filled)

IMPORTANT: Maintaining the community’s health and safety are our priority. Please be mindful for the following SCHC IPAC guidelines we will be following for in-person programming:

Located at The HUB, 2660 Eglinton Ave E, Scarborough, ON M1K 2S3
Travel reimbursement and light refreshments available.
COVID-19 Practice in Effect – Pre-screening, Masks, and Physical Distancing Required
A designated screening station will be setup at the front of the Hub
All participants are required to undergo screening and temperature checks with a touchless thermometer
Participants that have symptoms of COVID-19 will not be able to participate in programs. They will be asked to get tested at the local assessment center
Participants MUST wear a non-medical face covering There should be a minimum of two meters distance between participants and staff, using visual markers
We will have alcohol-based hand sanitizer available for use at the screening station.

Contact Danielle Lobo, Youth Bereavement Coordinator, dlobo@schcontario.ca, 647-524-6358
you can also DM for further inquires on Twitter, Instagram, or Facebook.

SUBMIT

To view more information on our Breavement Care programs, please click here.

Online Registration – HEAL – Hope Exists After Loss Youth Program

Contact UsPhone: (416) 642 9445Email: info@schcontario.caScarborough Centre for Healthy CommunitiesCharitable # 13036 4276 RR 0001

Contact Us
Phone: (416) 642 9445
Email: info@schcontario.ca

Scarborough Centre for Healthy Communities
Charitable # 13036 4276 RR 0001