Program Registration

Our programs and services are open to residents living in Peterborough City and County. If you are interested in participating in a program or service, complete the registration form below. Once you have registered, the Program Office will contact you.

Don't see the program or service you are interested in? Call our program office today at 705-740-8020.

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Family Doctor: *
If you don't have a family doctor, simply enter n/a
Legal FIRST Name: *
Legal LAST Name: *
Preferred Name (if applicable):
Preferred Contact Number: *
Date of Birth: *
To enter your date of birth, simply click where it says dd and type in the day, click where it says mm and type the month, and click where it says yyyy and type the year.
MM
/
DD
/
YYYY
Postal Code: *
Please record in the following format A1A 1A1
Email Address: *
Email addresses will be used for the purpose of administering virtual programming.
I would like to register for the following: *
How did you hear about this program?
Optional Notes:
Additional Comments:
Privacy Policy / Disclaimer
“I understand and accept that by registering for a Peterborough Family Health Team program that I am submitting my name, phone number, date of birth, postal code, email address, and the name of my doctor through this form. This information will be used for the sole purpose of tracking and administering my registration in the program I selected.”
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