weekly email form (airfryer)

Please fill out the form below to reserve a spot for this Saturday.

This program requires monthly invoicing, However it is passport funding & SSAH friendly.
Name (Guardian/CareProvider)

First NameLast Name
Name (Who are you reserving for?)

First NameLast Name
Email
example@example.com
Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
2nd Emergency Contact
Please enter a valid phone number.Format: (000) 000-0000.
See Below For Time Slots Available, Alergies & Eligibility
Select an option below)
Available memberships (optional)

Saturdays (1 spot left) - $340/mo
Available memberships (optional)

Friday (3 spots left ) - $300/mo
choose your start date (Fri or sat)

MonthDayYear
Date
Any Allergies ?
Describe Allergies
Special Note on Allergies and Concerns
When using shared kitchen appliances like air fryers, do you have any specific cultural, religious, or personal requirements regarding food contact? (For example: Not using the same basket for meat and vegetarian items, specific cleaning rituals, or avoiding certain food groups entirely
IMPORTANT - NOTICE

Eligible Participants

Participants should generally meet the following profile as a minimum requirement:

Gross Motor Skills: 6/10
Communication Skills: 5/10
Independence: 5/10
Receptivity to Instruction: 7/10
Challenging Behaviours Requiring Clinical Therapy: 0/10

This program is not designed for individuals who require active behavioural or clinical intervention.

If eligibility is unclear or you’re unsure whether this program is the right fit, please contact us directly at Reclifegma@gmail.com to discuss individual circumstances.
Do you consent to having us send & upload progressive videos on our instagram page @reclifegma and website reclifegma.ca
Media Release signature
Address : 6033 Shawson Dr, Mississauga, ON L5T 1H8 , UNIT 22
What's next ?

We will call/email to confirm attendance; take Note of the upcoming Date/Time . Email us for any questions/concern : Reclifegma@gmail.com
Should be Empty:

Please fill out the form below to reserve a spot for this Saturday.

See Below For Time Slots Available, Alergies & Eligibility

Available memberships (optional)

Available memberships (optional)

Address : 6033 Shawson Dr, Mississauga, ON L5T 1H8 , UNIT 22

What's next ?