"*" indicates required fields

Name*
Address*
Date of Birth*
Gender*

*Stating a preferred language does not guarantee that we will serve you in that language. When possible, reasonable attempts will be made to communicate with you in the language of your choice if we have an available staff or volunteer who speaks the language.
Preferred Method of Communication*
Preferred Method for Receiving Quarterly Bulletin*
Do you use an assistive device?

Would you like a tour of the Centre and the programs offered here?

Emergency Contact Information

Emergency Contact # 1 - Name*
Emergency Contact #2 - Name

Medical Information

Will you be accompanied by an attendant/personal support worker?*
Do you have any medical conditions or personal needs we should know about?*
Do you have a Medical Alert Bracelet or Card?*

United Way Statistics

Please note: The information collected in the following 7 questions is for statistical and reporting purposes only (which has a direct impact on our funding) and will remain strictly confidential.
Are you a person with a Disability?*
A disability is a physical or mental impairment which has a substantial and long term adverse effect on a person's ability to carry out normal day-to-day activities.
Are you an Immigrant/New Canadian?*
Individuals born outside of Canada who came to Canada during the last 10 years.
Are you a Visible Minority?*
Individuals who are neither Caucasian nor Indigenous.
Are you a Francophone?*
People whose first official language is French and are capable of conversing in French.
Are you Indigenous?*
People who are a member of the First Nations, Métis, or Inuit.
Are you a member of the 2SLGBTQIA+ community?*
Two-Spirit, Lesbian, Gay, Bisexual, Transgender, Queer or Questioning, Intersex, Asexual, Represents other identities and expressions not explicitly listed
Are you a Rural Resident?*
Those living in Wards 4 (Kanata North), 5 (West Carleton-March), 19 (Cumberland), 20 (Osgoode), and 21 (Rideau-Goulbourn).
Note that this membership period runs from April 1, 2026-March 31, 2027.

Privacy Statement

The Good Companions respects your privacy. We protect your personal information and adhere to all legislative requirements with respect to privacy. We use your personal information to provide tax receipts and to mail out quarterly information packages to keep you informed about activities including special events, information updates, funding needs and opportunities to volunteer or give. If at any time you wish to be removed from any of these mailings, please call 613-236-0428, extension 2100.
Price: $ 30.00 CAD
To add a parking pass, enter "1" in the quantity field.
Payment Method