Intake Form Payment

Intake Form Submission and Payment

On this page you will submit your completed intake form in PDF or Word format and pay the intake review fee. Links to registration will be emailed to you after Intake Forms are reviewed. We will review Intake Forms weekly and send the registration link out every Monday. Registration is on a first come first served basis and begins on March 11, 2022 at noon!

Name *

First

Last

Camper's Name *

First

Last

Email *

Phone *

Address *

Address Line 1

Address Line 2

City

State / Province / Region

Postal Code

Country

Please upload your completed intake form here (PDF) *

*NOTE - For legal reasons, Intake forms must include a hand signed wet signature. E-signatures will not be accepted*

Please upload Psycho-Educational Assessment here if available (PDF)

Please upload a recent IPP here if avaiable (PDF)

Available Items *

Intake Fee - $ 30.00

Total Amount

$ 0.00

Stripe Credit Card *

Card

Name on Card

Comment or Message

CQR Centre For Opportunity

We offer a variety of services and programs for children, youth and young adults with moderate to severe disabilities. Summer Camp, Before and After Care, Life Skills Transition Program

Intake Form Payment

Intake Form Submission and Payment

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Intake Form Submission and Payment

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