"pathway to endless opportunities"

(905) 686-9532

To be placed on our Interest List and receive updates on Tania's Place programs please fill in the following information.  Your email address and personal information will not be given to anyone with out your permission in accordance to our privacy policies.

Name of Child:
Age: Male Female
Date of Birth:
Describe Disability:
Will be graduating:   or  Has graduated

Parent First Name:
Parent Last Name:
Daytime Phone:
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Evening Phone:
E-mail:
E-mail Preference:
Address:
City:
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Activity Centre/Day Program

  Full Day 5 days a week     Daily    Full Days Semi High 2-1 

Full Day 5 days a week High Needs 1 - 1 

Other Programs and Services

Summer Camp      March Break      P.D. Days      Super Saturday

Saturday Night Social

Start Date/Month:

 

Thank you for your interest and we look forward to working with you and your son/daughter