Friendly Calls program sign up form

This form can be used by people to sign themselves up to the Friendly Calls program, or by people looking to refer someone who may benefit from its services.

Who are you referring?

I am signing myself up. I am referring someone else.

Participant First Name

Participant Last Name

Address Line 1

Address Line 2

City/Town

Province/Territory

Postal Code

Email Address

Phone Number

Do you have any accessibility needs we should be aware of?

How did you hear about the Friendly Calls Program?

Do you agree to be contacted by the Friendly Calls Program?

Yes No

reCaptcha