Skip to main content
Events & Volunteer
Careers
Resources
Hit enter to search or ESC to close
Close Search
Menu
Home
Call Us
Directions
Events
Testimonials
Get In Touch
Programs
Admissions
Recovery Programs
Success Stories
About
The Facility
Our Staff & Board
Join Our Board
Careers
Join Our Society
Gratitude Reports
Contact
Send Us A Message
Feedback
Donate
Apply
Family Program Form
GENERAL INFORMATION
Attendee 1
Name
(Required)
First
Last
Address
(Required)
Street Address
Address Line 2
City
Alberta
British Columbia
Manitoba
New Brunswick
Newfoundland and Labrador
Northwest Territories
Nova Scotia
Nunavut
Ontario
Prince Edward Island
Quebec
Saskatchewan
Yukon
Province
Postal Code
Phone
(Required)
Alternate Phone
Email
(Required)
How did you hear about the Thorpe Recovery Centre Family Program?
Do you have any relationships – personal or otherwise, with any TRC staff?
Yes
No
Share a bit about that
EMERGENCY CONTACT INFORMATION
Emergency Contact:
Name
(Required)
First
Last
Relationship
(Required)
Phone
(Required)
Alternate Phone
Email
(Required)
Verbal and or written consent
(Required)
No
Yes
Do you have a spouse or children who have or are currently attending Thorpe Recovery Centre?
(Required)
Yes
No
Name(s)
Enrollment
Enrolment Date
(Required)
Method of Payment
(Required)
VISA
Mastercard
E-Transfer
A member of our accounting team will be in touch to finalize payment.
Number of Family Members attending.
(Required)
If more than 1 attendee, please complete the following for each addition attendee
GENERAL INFORMATION
Attendee #2
Attendee 2 Name
First
Last
Address
Street Address
Address Line 2
City
Alberta
British Columbia
Manitoba
New Brunswick
Newfoundland and Labrador
Northwest Territories
Nova Scotia
Nunavut
Ontario
Prince Edward Island
Quebec
Saskatchewan
Yukon
Province
Postal Code
Phone
Alternate Phone
Email
EMERGENCY CONTACT INFORMATION
Emergency Contact:
Name
First
Last
Relationship
Phone
Email
Verbal and or written consent
Yes
No
GENERAL INFORMATION
Attendee #3
Name
First
Last
Address
Street Address
Address Line 2
City
Alberta
British Columbia
Manitoba
New Brunswick
Newfoundland and Labrador
Northwest Territories
Nova Scotia
Nunavut
Ontario
Prince Edward Island
Quebec
Saskatchewan
Yukon
Province
Postal Code
Phone
Alternate Phone
Email
EMERGENCY CONTACT INFORMATION
Emergency Contact:
Name
First
Last
Relationship
Phone
Alternate Phone
Email
Verbal and or written consent
Yes
No
Close Menu
Home
Call Us
Directions
Events
Testimonials
Get In Touch
Programs
Admissions
Recovery Programs
Success Stories
About
The Facility
Our Staff & Board
Join Our Board
Careers
Join Our Society
Gratitude Reports
Contact
Send Us A Message
Feedback
Donate
Apply
Events & Volunteer
Careers
Resources