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Register for Aging Well and Connected

For older adults interested in social connection, practical learning and community activities. AFIWI will confirm available activities and any program specific eligibility.

Complete only the parts that apply. You may ask AFIWI staff to help you fill this out.

Your Contact Details

Please contact me by

Participation

I would like to attend

For example, large print, interpretation, step free access, or a different way to communicate. You do not need to provide a diagnosis.

How did you hear about this program?

Activities of Interest

Activities

Optional contact person for a program day concern. AFIWI will use this only if it needs to reach someone about your wellbeing during an activity.

Please discuss mobility, food or activity related needs with staff before the relevant activity. Do not include diagnoses or detailed medical history here.

Privacy and Contact

AFIWI will use the information on this form to respond to your request, plan participation and contact you about this program. Staff will share it only with people who need it to arrange the program, subject to AFIWI's privacy practices. Please ask staff how to access or correct your information.

Optional permissions. These do not affect registration.

Photo or video permission, if needed, must be requested on a separate form.

Type your full name to sign this registration.