BWC Registration In Person

Brain Wave Cafe Registration

This information will be used in the event a Brain Wave Cafe session has to be rescheduled or cancelled. Please complete this form once per person who will attend the group. Participants must be able to engage independently in the program or be accompanied by a care partner. Please note this is not a respite program and staff are unable to provide personal care support, physical or medical assistance, and are not able to prevent participants from leaving the venue.
Brain Wave Cafe Location you would like to attend*
Brain Wave Cafe - St. Catharines

Dates: 1st and 3rd Thursday of the month
Time: 1:30 - 3:00 pm
Place: Royal Canadian Legion Br 138 (2 Chestnut Street E, Merritton)

Description:

Brain Wave Cafés offer an informal place to meet up with other people with similar experiences on a regular basis. It's a great spot to have a coffee together, get information, share experiences and participate in 'healthy brain' activities within your local community.
Brain Wave Cafe - Niagara Falls

Dates: 2nd and 4th Wednesday of the month
Time: 1:30 - 3:00 pm
Place: Chapel Heights Retirement Residence (7373 Niagara Square Dr., Niagara Falls)

Description:

Brain Wave Cafés offer an informal place to meet up with other people with similar experiences on a regular basis. It's a great spot to have a coffee together, get information, share experiences and participate in 'healthy brain' activities within your local community.
Brain Wave Cafe - Beamsville

Dates: 1st and 3rd Thursday of the month
Time: 1:30 - 3:00 pm
Place: Beamsville Legion (5545 King St., Beamsville)

Description:

Brain Wave Cafés offer an informal place to meet up with other people with similar experiences on a regular basis. It's a great spot to have a coffee together, get information, share experiences and participate in 'healthy brain' activities within your local community.
Brain Wave Cafe - Welland

Dates: 1st and 3rd Tuesday of the month
Time: 2:00 - 3:30 pm
Place: Welland Community Centre (145 Lincoln St., Welland)

Description:

Brain Wave Cafés offer an informal place to meet up with other people with similar experiences on a regular basis. It's a great spot to have a coffee together, get information, share experiences and participate in 'healthy brain' activities within your local community.
Brain Wave Cafe - Ridgeway

Dates: 1st and 3rd Wednesday of the month (Starts September 2023)
Time: 1:30 - 3:00 pm
Place: Beachcombers Senios Centre (237 Ridge rd North, Ridgeway)

Description:

Brain Wave Cafés offer an informal place to meet up with other people with similar experiences on a regular basis. It's a great spot to have a coffee together, get information, share experiences and participate in 'healthy brain' activities within your local community.
Le Petit Café - Welland

Dates: 1ᵉʳ et 3ᵉ mercredi de chaque mois
L'heure: 13h00 - 14h30
Lieu: La Residence Richelieu (649 Tanguay Ave, Welland, ON)

Le Petite Café sera de retour à partir du mercredi 17 juillet à son nouveau domicile, La Residence Richelieu, en collaboration avec le Centre de santé communautaire.

Description:

Le Petit Café offrent un lieu informel où l'on peut rencontrer régulièrement d'autres personnes ayant des expériences similaires. C'est un endroit idéal pour prendre un café ensemble, obtenir des informations, partager des expériences et participer à des activités "cerveau sain" au sein de votre communauté locale.

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Dates: 1st and 3rd Wednesday of the month
Time: 1:00 - 2:30 pm
Place: La Residence Richelieu (649 Tanguay Ave, Welland, ON)

Le Petite Café will return starting Wednesday, July 17th at its new home, La Residence Richelieu, in collaboration with Centre de santé communautaire.

Description:

Brain Wave Cafés offer an informal place to meet up with other people with similar experiences on a regular basis. It's a great spot to have a coffee together, get information, share experiences and participate in 'healthy brain' activities within your local community.
Participant Name*

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Address*

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E-mail*
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Are you a returning friend who has registered for an Alzheimer Society of Niagara Region program in the past (including Brain Wave Cafes)?*

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The Alzheimer Society Niagara Region is committed to providing the highest quality of support and services to our community. To help us understand better the population we serve, we are requesting additional demographic information. Gathering this information not only helps us tailor our programs to meet the unique needs of our community, but it also plays a crucial role in our ability to apply for and receive funding through Ontario Health and private grants, which require detailed demographic data to support our initiatives. As a healthcare custodian, we are responsible for collecting, managing, and protecting this information in compliance with all applicable privacy standards. Your participation in providing this data helps ensure that we can continue delivering effective, person-centered care to those impacted by dementia.

If you prefer not to answer a specific question, you may choose that option in the questions drop box.
Language Spoken at home
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Gender
Racial or Ethnic Group
Date of Birth

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Date
Health Card Number
Health Card Version
Disclaimer

This information will be used for statistical purposes and will be stored on our electronic database; it will be kept confidential and will not be shared outside of our organization. I freely consent to participate in the offered program that will be led by an Alzheimer Society staff member or volunteer. I acknowledge that it is my choice to participate in this activity and I understand that I am free to withdraw from, reduce or modify my involvement in any part of this activity. I understand the program is not a supervised respite service and I must be able to independently participate. For programs where food is served, I understand that the organization can only serve store bought, pre-packaged foods, and cannot guarantee an allergen-free environment. I understand the Alzheimer Society of Niagara Region has taken reasonable safety precautions, including following Ontario Public Health recommendations, as a response to Covid-19. I agree to indemnify and hold the Alzheimer Society of Niagara Region harmless from any and all claims, actions, suits, procedures, costs, expenses, damages and liabilities, including attorney’s fees brought as a result of my involvement. In the event that a program session must be cancelled due to unforeseen circumstances, we will attempt to contact you if given permission above. Participants are encouraged to phone the Alzheimer Society of Niagara Region regarding program changes.
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Brain Wave Cafe Registration