RE/ACT Program Application Form Step 1 of 5

Sign up for our out-patient program today at one of our centres by filling out the following form. If you are interested in joining one of our Online RE/ACT programs, please fill out the RE/ACT Online Application form.

Please note our RE/ACT Centre in Winnipeg is closed until 2022 as we complete some corporate restructuring. Stay tuned by visiting

    Required Fields

    General Info

    *This allows us to access all resources available to us from government or other organizations in your area.

    Have you previously attended any of our programs? Please check all that apply.

    Emergency Contact

    Social Services Information