Waterloo Region 24/7 Crisis Line: 1-844-437-3247 | Call Us: 519-669-8651 | info@woolwichcounselling.org

Workshops and Groups Registration

Thank you for your interest in our programs. Please fill out the form below.

We will contact you for further information if needed.

Information submitted is kept confidential.



    Please enter the name of the group or workshop you're interested in:



    Please enter your full name.



    Please enter the full name of the person attending the program.



    Please enter the date of birth of the person attending the program.



    Please enter the gender of the person attending the program.



    Please enter the email address of the contact person.



    Please enter your phone number.



    Please enter your full address including street number, street name, town/city, postal code.



    *Required fields.

    7+2=




    Note: You will first receive an email from us (sender is no-reply@socialsolutions.com) with the consent form called “Workshop or group orientation and general consent” that you can fill out and return electronically.

    An email closer to the time of the workshop will be sent with the Zoom link.

    By providing your email address in this form, you consent to us contacting you to provide services and information. You can contact us at 519-669-8651 to register if you choose not to provide your email address.

    If you have any questions, please call us at 519-669-8651 or email us at info@woolwichcounselling.org.