Skip to Main Content
Select a Category
BOOST National Curling
Community Resource Centre Intake Form
signing in or creating an account
, some fields will auto-populate with your information and your submitted forms will be saved and accessible to you.
Sign in to Save Progress
The Great Disconnect Screening Event Survey
This form has been modified since it was saved. Please review all fields before submitting.
1. As a result of the Great Disconnect event, I have a greater understanding of the impact of loneliness on my community.
2. As a result of the Great Disconnect event, I have a greater understanding of why social connectedness is important to my community.
3. Which elements of the event did you like the most?
4. We are compiling a Connect and Belong Resource Guide, could you share any helpful resources that we could pass along to other community changemakers?
5. What other topics would you be interested in learning more about?
6. Would you like to be notified about upcoming workshops and webinars?
If 'Yes' please provide your email
Leave This Blank:
Receive an email copy of this form.
This field is not part of the form submission.
* indicates a required field
Slideshow Left Arrow
Slideshow Right Arrow