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Come Alive

56 reviews

Last Chance

240 Davis Rd, Gabriola Island, BC V0R 1X1, Canada

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1 Welcome

3 People in your group

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

After completing this form, emails will be sent to everyone in your group to complete their information.

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5 Optional Items

6 Tell us more about you

Preferred name	If different than first name - the name you go by.
Pronouns
Phone	Best number to reach you about your registration.
Phone - cell	Cell or mobile phone.
Address *
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
Diet Notes *	Regular (includes meat option when available) Vegan Vegetarian Pescatarian Gluten Free Dairy Free Medically severe allergy The meal package includes either a regular or vegetarian/pescatarian option. Other special requests (gluten free, vegan, dairy free) will be accommodated at an extra charge of $5/day.
Additional dietary info	Is there any particular meat or other food you don't eat? Anything else we should know about your food preferences?
Medical Information	medications, surgeries, current issues.
Additional rooming information	Examples: request a specific roommate, no stairs, etc.
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
Terms and Conditions *	I accept the terms and conditions.View terms and conditions. Some online program sessions may be recorded. Audio and visual of participants will not be shared without prior consent.
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.
How did you hear about this program? *	The program leader's website, email, or social media Email from The Haven The Haven's Social Media A friend or family member The Haven's Website During another Haven program Doctor, counsellor or medical professional alive magazine article Please check all that apply and provide the name of the person referring you if this applies.

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7 Payment

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Donations	$0

Taxes	$0

Deposit	$0

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	Interac eTransfer - to accounts@haven.ca Read more about Interac e-Transfer. Click on the button below and these instructions will be repeated on the next page.

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

Come Alive

1 Welcome

2 Choose your accommodation

Note that the meal package is added automatically*

Dorm bed (upper) - Participant

Dorm bed (lower) - Participant

Basic Room - Shared - Participant

Basic Room - Private - Participant

Forestview - Shared - Participant

Forestview - Private - Participant

Forestview Kitchen - Private - Participant

Gardenview Suite - Private - Participant

Oceanview Room - Private - Participant

Oceanview Suite - Private - Participant

Oceanfront Cabin 2 bedroom - Private - Participant

Staying off-premise - Participant

3 People in your group

4 Additional Programs

Participants

5 Optional Items

6 Tell us more about you

7 Payment