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.

Submit
Never submit passwords through Google Forms.
This form was created inside of PACT Urban Peace Program. Report Abuse - Terms of Service - Additional Terms