I CARE

*required

Names of organizations / churches / communities I identify with:

Organizations/Churches/Communities will not be contacted on your behalf.

I care for children and families as a (check all that apply):

Church Member

Community Member

Social Worker/Child Serving Professional

Parent/Caregiver

Professional/Business Person

Foster Alumn/Adoptee

Church Pastor/Leader

Non-Profit Leader

Other

Other Response

My main interest(s) (check all that apply):

Let's keep in touch - I may want to get more involved

I'm interested in activating my community to effectively journey with children and families from hard places

I'd like to introduce the CarePortal platform to my church/agency/organization/community

I'm interested in participating in the CareImpact Academy's online learning community

I've got a few questions or ideas I'd like to discuss

I'm a networker and know people you should meet

CareImpact is something I could get behind

Other

Postal Code

Province/Territory

Last Name

First Name

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Church/Agency Name

I represent a church or organization (optional)

Postal Code