Register for ACT Programs

Fill out the form below to register for Quill & Chill!

You will receive a confirmation email when your registration is complete. If you do not receive a confirmation email, please check your junk mail. 

Who would you like to register for this program?

An Adult and a YouthA Youth (13 - 18 years)An Adult (over 18)

Session Name

Session ID

Registration Closed?

Session at Capacity?

Notice

Thank you for your interest, this session is now full. 

If you would like to view other sessions we are offering click here.

Session Information

Start Date

Time

Cost (CAD)

Cost (CAD)

Details

For ages 12+ | October 30 | 5:00pm - 7:00pm

Location

Room

Youth Information

Youth's First Name

Youth's Last Name

Birthdate

School Youth Currently Attends

Does your participant have any medical conditions, allergies, or medications we should know about?

YesNo

If yes, please specify below

Adult Information

Adult's First Name

Adult's Last Name

Phone Number

Email Address

Address

Town/City

Postal Code

I would like to be added to the ACT Program email mailing list. (Optional)

Emergency Contact Information

Please provide the contact information of someone other than the Parent/Guardian listed above.

In the event of an emergency, we will first attempt to contact the Parent/Guardian. If we are unable to reach them, we will need an alternate Emergency Contact.

Emergency Contact First Name

Emergency Contact Last Name

Emergency Contact Phone Number

Relationship to Child

Please select... Parent/Guardian Friend Aunt Uncle Grandparent

View the photo/video consent terms

I have read and agree to the photo/video consent terms and I grant MCRC permission to use photos of my participant on their social media accounts, website, and on promotional materials.

View the refund policy

I have read and agree to the refund policy

Payment Information

Total Amount Due:

Name on Card

Card Number

MM

YY

Code

Billing Email