Enrolment

Please complete the enrolment request for Reaching for Rainbows and return it to the person/school/agency where you received it, or to amanda@reachingforrainbows.com.

You can also mail the form to:

Reaching for Rainbows
31 King Street
Picton, ON K0K 2T0

Enrolment Form

Rainbows will contact you to arrange a consultation, and discuss if there is availability to accommodate your child.

Child's Name

First Name

Last Name

Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Birthdate

MM

DD

YYYY

School

Parent/Guardian

First Name

Last Name

Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Phone

(###)

###

####

Email

Intake Questions

Question 1: How can Reaching for Rainbows support your child?

If you have any questions or concerns, please don't hesitate to get in touch with us.