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Program Participant Form

WISE Mobile Active Living Centre offers free programming for residents in Muskoka 55+. If you would like to participate in our programs through the please complete the form below. WISE Should you have any questions regarding this form or our programs, please call our Seniors Programs and Services team at 705-645-2100 ext. 4199. Please note that you will need to contact us to register for individual programs of interest. Thank you and we look forward to you joining us!

First Name:

Last Name:

Please provide your Mailing Address within the Muskoka region (Including unit number, PO Box, RR if applicable):

Town/City:

Postal Code:

Main Phone Number:

Cell Phone Number:

Email Address:

Would you like to receive program information by email?

Yes

Date of Birth:

Would you like to receive a birthday card annually from our Peer Support Committee?

Yes

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Program Participant Form

Emergency Contact Information: