and Mental Health
First Name: *
Last Name * :
Your Date of Birth – Please complete (dd/mm/yyyy): *
Gender: –None–MaleFemaleUnknownNon-BinaryTransgenderIntersexPrefer not to discloseOther
Gender Pronouns: –None–She/HerHe/HimThey/ThemOther (Describe)
Gender Pronouns – Other:
Phone: (Leave us your phone number so we can follow-up with you)
Do you have a diagnosis of ADHD?
What do you hope to learn in the Let’s Talk ADHD group?
The cost of this program is $490.
If you are paying by eTransfer, please payment send to [email protected] Indicate your name and the program name you are registering for in the message.
If you are paying by credit card, please call Reception at 403-686-9300 Ext. 100, Monday to Friday from 8:30 AM to 4:30 PM.
We have funding available to help those impacted by the COVID pandemic. If you require financial support for this program, please complete the questions below.
Because of the pandemic, I have been impacted financially: –None–YesNo
Because of the pandemic, my mental health has been impacted: –None–YesNo
Please explain how you have been impacted by the pandemic:
Our Program Coordinator will be in contact by email to confirm registration.
If you have questions or concerns about Adult ADHD Group, contact Jaime Gaber by email.
CanLearn may transfer personal information to outside service providers that perform services on our behalf such as client relations management systems, or similar services. These service providers are located and store data in Canada. By providing personally identifiable information to us, you agree to the transfer of your personal information to a server located in Canada. More information about our privacy policies and practices can be accessed by contacting Laura Godfrey at 403-686-9300 ext. 126 or by clicking here.