Certificate / Diploma Student Registration

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* These fields are required

1 Welcome

2 Choose your accommodation

3 People in your group

Guest 1		First Name* Last Name* Email* Gender
Guest 1		First Name* Last Name* Email* Gender

5 Tell us more about you

Preferred name	Different than first name, what you are called or the name you go by. If you're joining us online, it's helpful if your registration matches your name on Zoom.
Phone - cell	Cell or mobile phone. Please note that your email and phone number may be shared with the program leaders. View terms and conditions for more details.
Phone - work	Work or office phone, if we need to reach you about your registration.
Address	This is where we will mail any tax receipts.
Address 2
City
State/Prov.
Zip/Postal
Country
Gender
Birth Date *	A participant must be 19 or older to register for an adult program at The Haven
Additional dietary info	Is there any particular meat or other food you don't eat? Anything else we should know about your food preferences?
Emergency contact	Who should we contact in the event of a personal emergency? Please choose someone who will be available during the program.
Emergency contact phone	Phone for your emergency contact.
Emergency contact relationship	This person is my ____.
Is there anything else you'd like to tell us?	Please provide any other information that you would like us to consider when processing your registration request. If you would prefer to speak directly with a Registrar please email register@haven.ca
Email communications	Yes, I agree to receive additional resources, special offers, and occasional updates related to opportunities at The Haven.As part of your program registration, you will receive a few essential emails from us related to your experience. Beyond that, we hope you'll opt in to stay connected. You can unsubscribe at any time.

6 Donate to The Haven

7 Payment

Autofill will update info above!
If you are registering someone other than the cardholder, please enter credit card number manually.

50% Deposit	$0

Pay	Choose to pay a deposit or the full amount right now.

Due Now	$0 $0

Choose Payment Option

First Name
Last Name
Card Type
Card Number *
Card Expiration *	Month Year
Card Security Code	usually a 3 digit code on back of card