Intake form

Help us serve you better

Name *

Email address *

What age group do you belong to?

Which services are you interested in?

Please select at least one option.

Sports and Fitness

Education and Training

Creativity

Mentorship

Counselling

Community Engagement

Please specify any specific interests or skills you would like to develop.

How did you hear about free circle CIC?

Do you have any previous experience with community programs?

What challenges are you currently facing that you would like support with?

Are you currently employed or studying?

What is your preferred method of contact?

Which service or services are you interested in?

Please select at least one option.

Freebies

Circles

Events

Additional questions or comments

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