Required fields are marked with asterisks (*)

2020 Accessibility Accommodation Plan

Please complete the information on the form. Please print and sign it and bring it to the Customer Service Desk at the Quinte Sports & Wellness centre or email it to rccsgeneral@belleville.ca

Program Name

Program Date(s)

Add Remove

Participants Name

Address

City or Town

Province

Postal Code

Phone Number (Main)

Phone Number (Other)

Parent or Guardian Name (if participant is under 18)

E-mail Address of parent or guardian

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