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.

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