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Activity Registration Form

Please fill out the information below for the person participating in the activity. If you're signing up more than one participant please fill out a second form.

Name of participant
Birth Year
Birth Year
Gender
City
City where you are located or municipality (if outside the Laurentians options are: "Montreal", "Greater Montreal" or "Laval". If outside of Quebec select "Out of province")
Ethnicity
Is the participant a caregiver?
Someone who provides care and support to another individual who may be unable to care for themselves due to age, illness, disability, or other circumstances
Privacy Policy
By checking this box, you agree to our privacy policy. https://4korners.org/privacy-policy-4korners/
Do you agree to be photographed as part of our community activities?

Do not submit passwords through this form. Report malicious form