Life & Job Skills Programs Registration
All PACT programs are free-of-charge for youth ages 13-21. Please forward any questions to Andrea Black at referrals@pactprogram.ca or 647-967-9991.

*Please note that we will contact you (youth, parent or referral agent) for confirmation, so please provide all contact information.

Email address *
Name of Program *
Required
Full name of youth *
Your answer
Parent or guardian name if youth is under 18
Your answer
Phone number of youth *
Your answer
Phone number of parent or guardian if youth is under 18 *
Your answer
Youth Email
Your answer
Age of youth *
Gender identity of youth
What school does the youth attend?
Your answer
Referral Information
Full name of referral agent *
Your answer
Agency/program
Your answer
Will a host or chaperone be attending a program with the youth? *
Are there any developmental disabilities or mental health issues we should be aware of? *
Your answer
How did you hear about PACT? *
Your answer
Phone number and email of referral agent
Your answer
Any additional special instructions or important information about the young person?
Your answer
Registration Follow-Up
This information will be sent to PACT Administration Coordinator Andrea Black who can also be reached at 647-967-9991 or referrals@pactprogram.ca.

Andrea will follow-up directly with the youth or parent/guardian contact to confirm registration, answer any questions and provide additional information.

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This form was created inside of PACT Urban Peace Program.