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Recreation & Leisure Services
> Recreation & Leisure Services New Agency Registration
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Randy Miller
Co-ordinator
Phone: 905-575-2159
Fax: 905-575-2094
Email Randy Miller
Sue Vattay
Field Placement Co-ordinator
Phone: 905-575-2158
Fax: 905-575-2094
Email Sue Vattay
Canadian Association for Leisure Studies (CALS)
Canadian Therapeutic Recreation Society (CTRA)
Therapeutic Recreation Ontario (TRO)
Parks & Recreation Ontario (PRO)
Lifestyle Information Network
World Leisure and Recreation Association
Degree Transfer with University of Waterloo
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Recreation & Leisure Services New Agency Registration
Page 1 of 1
Are you:
a new agency registering for the first time
an existing agency updating your information
Internal Update
Recreation & Leisure Services New Agency Registration
Agency Information
Agency Name:
Contact Person:
Contact Email:
Enter a valid email address. Example: name@company.com
Address Line 1:
Address Line 2:
City, Province:
Postal Code:
Contact Phone:
Enter a valid phone number. Example: 123-456-7890
EXT:
Agency Fax:
Enter a valid phone number. Example: 123-456-7890
Website:
Placement Information
Placement Location - Nearest Intersection and/or Address (if different than above):
Head Office Information
Main Agency Name or Head Office Information (Required)
Head Office Name:
Address Line 1:
Address Line 2:
City, Province:
Postal Code:
Person with Signing Authority (CEO or Director):
Title:
Description of Agency:
Student Information
Student Responsibilities/Activities:
Placement Supervisor:
Major Client Group Served:
Required for placement:
Police Check
WSIB Coverage
Drivers License
CPR/First Aid
TB Test
Smart Serve
Advanced Computer Skills
Flu Shot
Would you accept:
1st year winter
2nd year fall/winter
1st year spring/summer
Total number of students you could accommodate per semester:
Preferred hours the student may be required (check all that apply):
Weekdays
Weekends
Weekday evenings
Other requirements (please specify):
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P.O. Box 2034, Hamilton, ON, Canada L8N 3T2 905-575-1212
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Last Updated:10/31/2008 10:23:54 AM
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