Name
*
First Name
Middle Name
Last Name
Age Category
*
Under Age 25
Ages 25 - 34
Ages 35 - 44
Ages 45 - 54
Ages 55 - 64
Ages 65+
Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Would you like to be added on our WhatsApp group?
*
Yes
No
WatsApp number (if different from your phone number)
E-mail
example@example.com
Country of Origin
Language Speaking
How did you hear about us?
Word of Mouth (Family, Friends)
Social Media (Facebook, etc.)
Kitchener Library
Community Centres
Website
Other
Which Community Centre(s) will you be attending?
Downtown Community Centre
Huron Community Centre
Chandler Mowat Community Centre
Any comment or suggestions?
SUBMIT
Should be Empty: