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Connect with us - We'd love to hear from you!
Please take a moment to tell us a bit about yourself and what programs you are interested in.
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First Name
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Your answer
Last Name
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Your answer
Email
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Your answer
Which city do you currently live in?
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Waterloo
Guelph
Kitchener
Wellington County (Mount Forest, Fergus, Elora, Rockwood)
Other:
Are you a brain injury survivor or caregiver?
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Survivor
Caregiver
Other:
Are you 55 years or older? (This information is only collected to inform funders of the demographic we serve)
Yes
No
Other:
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How do you prefer to stay informed?
Newsletter
Website
Instagram
X (Twiiter)
Other:
Clear selection
Are there any presentation topics you're interested in?
Your answer
What current programming do you currently enjoy or plan to try?
Tech talks
Art Program
Support Groups (virtual and in-person)
Drop in Calls
Brain Makers (cards, products for store)
Peer Support Program
Clear selection
Is there other programming you would like to see?
Book Club
Walking Group
Card/board games (share your favourite using the 'other' option below!)
Movie Night
Trivia at a local restaurant/pub
Jigsaw Puzzle
Poetry
Music/Open Mic
Other:
Are there any essential items you need?
Clothing
Hygiene Products (shampoo, soap, toothbrush/paste, feminine products)
Transportation
Baby items (clothing, formula, diapers etc)
Other:
Clear selection
Do you have unmet needs? (For example, essential items including food/clothing/transportation, or connections with others/isolation)
Your answer
What challenges do you experience?
Your answer
Any questions, comments or feedback?
Your answer
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