Waterloo Regional Block Parent® Contact Form
To receive an Information Package about Becoming a Block Parent, please fill out this form and our Block Parent Coordinator will email you as soon as possible. Thank you!
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How did you hear about the Block Parent Program? *
First and Last Name *
Email Address *
Street Address and City *
For more information visit www.blockparents.ca or email info@blockparents.ca 
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This form was created inside of Waterloo Regional Block Parent Program.