Weekly Check In Program
The goal of the Weekly Check-In Program is to minimize feelings of isolation among our community members as a result of the COVID-19 pandemic. Community members 18 years or older can choose to receive a weekly call or email from End of the Rainbow staff, at an agreed upon time, between Monday to Friday. During these conversations we will touch base on how you are doing, have a friendly chat with you, and offer information, updates and referrals should you need them.
Please let us know your name:
What age are you:
Is it safe for us to leave you a voicemail message on the phone number provided above:
Preferred method of Contact:
Do you have any accessibility needs you would like us to know about:
I understand that the Weekly Check-In program is not a counseling service or a crisis line. If I need immediate assistance, I will call the Distress Centre at (403) 266-4357, or 911.
To ensure continuity of care, by participating in the program you agree to personal information being shared between a small number of staff members involved in the administration, and facilitation of the program.
I understand the the Weekly Check In Program is voluntary, and I may choose to opt-in or opt-out at anytime.
Should be Empty:
Now create your own Jotform - It's free!
Create your own Jotform