registration

First Name *

Last Name *

Home Phone *

Your E-Mail Address *

Address 1 *

Address 2

City *

State/Prov *

Zip/Postal Code *

Country *

Cell Phone

Work Phone

Sex *

This will help us assign rooms for those sharing.

Male
Female

Date of Birth
/ /

Program Name *

Other

If you chose "Other" from the program list, please tell us in this box which program you would like to register for.

Program Start Date
/ /

Is this your first time at The Haven?
Yes
No

How did you hear about The Haven?

Other

If you chose "Advertisement" or "Other" in the How did you hear about The Haven box, then please explain here.

Room Type Requested *

Requested room is not guaranteed until confirmed by the Registrar. Visit the accommodations page to view examples of each room and pricing. Non-resident fee does not apply to Gabriola residents.

Basic
Forestview
Oceanview
Meals Only - No Accommodation. There is a $10 per day non-resident fee for guests staying in accommodation outside The Haven.
No Meals and No Accommodation. There is a $10 per day non-resident fee for guests staying in accommodation outside The Haven.

Private Room Requested

We assumed shared accommodation. If you are requesting a private room tick here (not guaranteed until confirmed by the registrar).

Dietary Restrictions/Allergies

Please enter any special dietary concerns, including allergies in this field.

Special Needs/Mobility Issues

To help us serve you better, please let us know if you have any other special needs, or mobility issues.

Additional Comments

If you have any additional comments or requests, please enter them here.

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