{"id":4811,"date":"2025-08-12T01:54:54","date_gmt":"2025-08-12T05:54:54","guid":{"rendered":"https:\/\/youngcaregivers.ca\/?page_id=4811"},"modified":"2026-03-23T10:46:05","modified_gmt":"2026-03-23T14:46:05","slug":"contact","status":"publish","type":"page","link":"https:\/\/youngcaregivers.ca\/fr\/contact\/","title":{"rendered":"Nous joindre"},"content":{"rendered":"<p>[et_pb_section fb_built=&#8221;1&#8243; admin_label=&#8221;Courses Hero&#8221; _builder_version=&#8221;4.21.0&#8243; use_background_color_gradient=&#8221;on&#8221; background_color_gradient_direction=&#8221;190deg&#8221; background_color_gradient_stops=&#8221;#b32572 0%|#870064 100%&#8221; background_color_gradient_start=&#8221;#474ab6&#8243; background_color_gradient_end=&#8221;#9271f6&#8243; background_image=&#8221;https:\/\/youngcaregivers.ca\/wp-content\/uploads\/2023\/02\/coding-background-texture.jpg&#8221; background_blend=&#8221;overlay&#8221; custom_padding=&#8221;20px|20px|20px|20px|false|false&#8221; animation_style=&#8221;slide&#8221; animation_direction=&#8221;top&#8221; animation_intensity_slide=&#8221;2%&#8221; locked=&#8221;off&#8221; global_colors_info=&#8221;{}&#8221;][et_pb_row _builder_version=&#8221;4.21.0&#8243; background_size=&#8221;initial&#8221; background_position=&#8221;top_left&#8221; background_repeat=&#8221;repeat&#8221; custom_margin=&#8221;-5px|auto||auto||&#8221; custom_width_px=&#8221;1280px&#8221; global_colors_info=&#8221;{}&#8221;][et_pb_column type=&#8221;4_4&#8243; admin_label=&#8221;Column&#8221; _builder_version=&#8221;4.21.0&#8243; custom_padding=&#8221;|||&#8221; global_colors_info=&#8221;{}&#8221; custom_padding__hover=&#8221;|||&#8221;][et_pb_text admin_label=&#8221;Text&#8221; _builder_version=&#8221;4.21.0&#8243; text_font=&#8221;Open Sans|300|||||||&#8221; text_text_color=&#8221;#000000&#8243; text_font_size=&#8221;16px&#8221; text_line_height=&#8221;1.4em&#8221; header_font=&#8221;|700|||||||&#8221; header_text_align=&#8221;center&#8221; header_text_color=&#8221;#FFFFFF&#8221; header_font_size=&#8221;64px&#8221; header_3_text_color=&#8221;#000000&#8243; header_4_text_color=&#8221;#000000&#8243; locked=&#8221;off&#8221; global_colors_info=&#8221;{}&#8221;]<\/p>\n<h1>CONTACT US<\/h1>\n<p>[\/et_pb_text][\/et_pb_column][\/et_pb_row][\/et_pb_section][et_pb_section fb_built=&#8221;1&#8243; _builder_version=&#8221;4.21.0&#8243; background_color=&#8221;#eeeeee&#8221; global_colors_info=&#8221;{}&#8221;][et_pb_row make_equal=&#8221;on&#8221; _builder_version=&#8221;4.21.0&#8243; global_colors_info=&#8221;{}&#8221;][et_pb_column type=&#8221;4_4&#8243; _builder_version=&#8221;4.16&#8243; global_colors_info=&#8221;{}&#8221;][et_pb_text module_id=&#8221;info-form&#8221; _builder_version=&#8221;4.21.0&#8243; global_colors_info=&#8221;{}&#8221;]<\/p>\n<script>\nvar gform;gform||(document.addEventListener(\"gform_main_scripts_loaded\",function(){gform.scriptsLoaded=!0}),document.addEventListener(\"gform\/theme\/scripts_loaded\",function(){gform.themeScriptsLoaded=!0}),window.addEventListener(\"DOMContentLoaded\",function(){gform.domLoaded=!0}),gform={domLoaded:!1,scriptsLoaded:!1,themeScriptsLoaded:!1,isFormEditor:()=>\"function\"==typeof InitializeEditor,callIfLoaded:function(o){return!(!gform.domLoaded||!gform.scriptsLoaded||!gform.themeScriptsLoaded&&!gform.isFormEditor()||(gform.isFormEditor()&&console.warn(\"The use of gform.initializeOnLoaded() is deprecated in the form editor context and will be removed in Gravity Forms 3.1.\"),o(),0))},initializeOnLoaded:function(o){gform.callIfLoaded(o)||(document.addEventListener(\"gform_main_scripts_loaded\",()=>{gform.scriptsLoaded=!0,gform.callIfLoaded(o)}),document.addEventListener(\"gform\/theme\/scripts_loaded\",()=>{gform.themeScriptsLoaded=!0,gform.callIfLoaded(o)}),window.addEventListener(\"DOMContentLoaded\",()=>{gform.domLoaded=!0,gform.callIfLoaded(o)}))},hooks:{action:{},filter:{}},addAction:function(o,r,e,t){gform.addHook(\"action\",o,r,e,t)},addFilter:function(o,r,e,t){gform.addHook(\"filter\",o,r,e,t)},doAction:function(o){gform.doHook(\"action\",o,arguments)},applyFilters:function(o){return gform.doHook(\"filter\",o,arguments)},removeAction:function(o,r){gform.removeHook(\"action\",o,r)},removeFilter:function(o,r,e){gform.removeHook(\"filter\",o,r,e)},addHook:function(o,r,e,t,n){null==gform.hooks[o][r]&&(gform.hooks[o][r]=[]);var d=gform.hooks[o][r];null==n&&(n=r+\"_\"+d.length),gform.hooks[o][r].push({tag:n,callable:e,priority:t=null==t?10:t})},doHook:function(r,o,e){var t;if(e=Array.prototype.slice.call(e,1),null!=gform.hooks[r][o]&&((o=gform.hooks[r][o]).sort(function(o,r){return o.priority-r.priority}),o.forEach(function(o){\"function\"!=typeof(t=o.callable)&&(t=window[t]),\"action\"==r?t.apply(null,e):e[0]=t.apply(null,e)})),\"filter\"==r)return e[0]},removeHook:function(o,r,t,n){var e;null!=gform.hooks[o][r]&&(e=(e=gform.hooks[o][r]).filter(function(o,r,e){return!!(null!=n&&n!=o.tag||null!=t&&t!=o.priority)}),gform.hooks[o][r]=e)}});\n<\/script>\n\n                <div class='gf_browser_gecko gform_wrapper gform_legacy_markup_wrapper gform-theme--no-framework' data-form-theme='legacy' data-form-index='0' id='gform_wrapper_1' style='display:none'>\n                        <div class='gform_heading'>\n                            <h3 class=\"gform_title\">Information Request \/ Registration Form<\/h3>\n                            <p class='gform_description'>If you would like more information on Young Caregivers Association\u2122 or our Powerhouse\u2122 program or would like to register, make a referral, become a volunteer, get involved, or request a community presentation, please complete the form below:<\/p>\n                        <\/div><form method='post' enctype='multipart\/form-data'  id='gform_1'  action='\/fr\/wp-json\/wp\/v2\/pages\/4811' data-formid='1' novalidate>\n                        <div class='gform-body gform_body'><ul id='gform_fields_1' class='gform_fields top_label form_sublabel_below description_below validation_below'><li id=\"field_1_17\" class=\"gfield gfield--type-honeypot gform_validation_container field_sublabel_below gfield--has-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_1_17'><span class='gform-field-label__text'>Facebook<\/span><\/label><div class='ginput_container'><input name='input_17' id='input_1_17' type='text' value='' autocomplete='new-password'\/><\/div><div class='gfield_description' id='gfield_description_1_17'>This field is for validation purposes and should be left unchanged.<\/div><\/li><li id=\"field_1_1\" class=\"gfield gfield--type-name gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label gfield_label_before_complex' ><span class='gform-field-label__text'>Name<\/span><span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_complex ginput_container ginput_container--name no_prefix has_first_name no_middle_name has_last_name no_suffix gf_name_has_2 ginput_container_name gform-grid-row' id='input_1_1'>\n                            \n                            <span id='input_1_1_3_container' class='name_first gform-grid-col gform-grid-col--size-auto' >\n                                                    <input type='text' name='input_1.3' id='input_1_1_3' value=''   aria-required='true'     \/>\n                                                    <label for='input_1_1_3' class='gform-field-label gform-field-label--type-sub '>First<\/label>\n                                                <\/span>\n                            \n                            <span id='input_1_1_6_container' class='name_last gform-grid-col gform-grid-col--size-auto' >\n                                                    <input type='text' name='input_1.6' id='input_1_1_6' value=''   aria-required='true'     \/>\n                                                    <label for='input_1_1_6' class='gform-field-label gform-field-label--type-sub '>Last<\/label>\n                                                <\/span>\n                            \n                        <\/div><\/li><li id=\"field_1_2\" class=\"gfield gfield--type-email gf_left_half gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_1_2'><span class='gform-field-label__text'>Email<\/span><span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_email'>\n                            <input name='input_2' id='input_1_2' type='email' value='' class='medium'    aria-required=\"true\" aria-invalid=\"false\"  \/>\n                        <\/div><\/li><li id=\"field_1_3\" class=\"gfield gfield--type-phone gfield--phone-format-standard gf_right_half field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_1_3'><span class='gform-field-label__text'>Phone<\/span><\/label><div class='ginput_container ginput_container_phone'><input name='input_3' id='input_1_3' type='tel' value='' class='medium'  placeholder='(999) 999-9999'  aria-invalid=\"false\"   data-mask=\"(999) 999-9999\" \/><\/div><\/li><li id=\"field_1_4\" class=\"gfield gfield--type-select field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_1_4'><span class='gform-field-label__text'>Location<\/span><\/label><div class='ginput_container ginput_container_select'><select name='input_4' id='input_1_4' class='large gfield_select'     aria-invalid=\"false\" ><option value='Niagara' >Niagara<\/option><option value='Haldimand-Norfolk' >Haldimand-Norfolk<\/option><option value='Other (please specify)' >Other (please specify)<\/option><\/select><\/div><\/li><li id=\"field_1_11\" class=\"gfield gfield--type-address field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label gfield_label_before_complex' ><span class='gform-field-label__text'>Other Location<\/span><\/label>    \n                    <div class='ginput_complex ginput_container has_city has_state ginput_container_address gform-grid-row' id='input_1_11' >\n                        <span class='ginput_left address_city ginput_address_city gform-grid-col' id='input_1_11_3_container' >\n                                    <input type='text' name='input_11.3' id='input_1_11_3' value=''    aria-required='false'    \/>\n                                    <label for='input_1_11_3' id='input_1_11_3_label' class='gform-field-label gform-field-label--type-sub '>City<\/label>\n                                 <\/span><span class='ginput_right address_state ginput_address_state gform-grid-col' id='input_1_11_4_container' >\n                                        <input type='text' name='input_11.4' id='input_1_11_4' value=''      aria-required='false'    \/>\n                                        <label for='input_1_11_4' id='input_1_11_4_label' class='gform-field-label gform-field-label--type-sub '>State \/ Province \/ Region<\/label>\n                                      <\/span><input type='hidden' class='gform_hidden' name='input_11.6' id='input_1_11_6' value='' \/>\n                    <div class='gf_clear gf_clear_complex'><\/div>\n                <\/div><\/li><li id=\"field_1_5\" class=\"gfield gfield--type-checkbox gfield--type-choice gf_list_2col field_sublabel_below gfield--has-description field_description_above field_validation_below gfield_visibility_visible gfield--choice-align-vertical\"  ><label class='gfield_label gform-field-label gfield_label_before_complex' ><span class='gform-field-label__text'>Reason for contact<\/span><\/label><div class='gfield_description' id='gfield_description_1_5'>check all that apply<\/div><div class='ginput_container ginput_container_checkbox'><ul class='gfield_checkbox' id='input_1_5'><li class='gchoice gchoice_1_5_1'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_5.1' type='checkbox'  value='To register my child\/family'  id='choice_1_5_1'   aria-describedby=\"gfield_description_1_5\"\/>\n\t\t\t\t\t\t\t\t<label for='choice_1_5_1' id='label_1_5_1' class='gform-field-label gform-field-label--type-inline'>To register my child\/family<\/label>\n\t\t\t\t\t\t\t<\/li><li class='gchoice gchoice_1_5_2'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_5.2' type='checkbox'  value='To register myself as a young caregiver'  id='choice_1_5_2'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_1_5_2' id='label_1_5_2' class='gform-field-label gform-field-label--type-inline'>To register myself as a young caregiver<\/label>\n\t\t\t\t\t\t\t<\/li><li class='gchoice gchoice_1_5_3'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_5.3' type='checkbox'  value='To refer a young caregiver\/family'  id='choice_1_5_3'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_1_5_3' id='label_1_5_3' class='gform-field-label gform-field-label--type-inline'>To refer a young caregiver\/family<\/label>\n\t\t\t\t\t\t\t<\/li><li class='gchoice gchoice_1_5_4'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_5.4' type='checkbox'  value='To receive information about services'  id='choice_1_5_4'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_1_5_4' id='label_1_5_4' class='gform-field-label gform-field-label--type-inline'>To receive information about services<\/label>\n\t\t\t\t\t\t\t<\/li><li class='gchoice gchoice_1_5_5'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_5.5' type='checkbox'  value='To request a presentation'  id='choice_1_5_5'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_1_5_5' id='label_1_5_5' class='gform-field-label gform-field-label--type-inline'>To request a presentation<\/label>\n\t\t\t\t\t\t\t<\/li><li class='gchoice gchoice_1_5_6'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_5.6' type='checkbox'  value='To become a volunteer'  id='choice_1_5_6'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_1_5_6' id='label_1_5_6' class='gform-field-label gform-field-label--type-inline'>To become a volunteer<\/label>\n\t\t\t\t\t\t\t<\/li><li class='gchoice gchoice_1_5_7'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_5.7' type='checkbox'  value='To join the Board of Directors'  id='choice_1_5_7'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_1_5_7' id='label_1_5_7' class='gform-field-label gform-field-label--type-inline'>To join the Board of Directors<\/label>\n\t\t\t\t\t\t\t<\/li><li class='gchoice gchoice_1_5_8'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_5.8' type='checkbox'  value='Register for an virtual program'  id='choice_1_5_8'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_1_5_8' id='label_1_5_8' class='gform-field-label gform-field-label--type-inline'>Register for an virtual program<\/label>\n\t\t\t\t\t\t\t<\/li><li class='gchoice gchoice_1_5_9'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_5.9' type='checkbox'  value='other (please specify)'  id='choice_1_5_9'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_1_5_9' id='label_1_5_9' class='gform-field-label gform-field-label--type-inline'>other (please specify)<\/label>\n\t\t\t\t\t\t\t<\/li><\/ul><\/div><\/li><li id=\"field_1_12\" class=\"gfield gfield--type-text gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_1_12'><span class='gform-field-label__text'>Referring Agency<\/span><span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_12' id='input_1_12' type='text' value='' class='large'     aria-required=\"true\" aria-invalid=\"false\"   \/><\/div><\/li><li id=\"field_1_14\" class=\"gfield gfield--type-name gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label gfield_label_before_complex' ><span class='gform-field-label__text'>Referring Contact<\/span><span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_complex ginput_container ginput_container--name no_prefix has_first_name no_middle_name has_last_name no_suffix gf_name_has_2 ginput_container_name gform-grid-row' id='input_1_14'>\n                            \n                            <span id='input_1_14_3_container' class='name_first gform-grid-col gform-grid-col--size-auto' >\n                                                    <input type='text' name='input_14.3' id='input_1_14_3' value=''   aria-required='true'     \/>\n                                                    <label for='input_1_14_3' class='gform-field-label gform-field-label--type-sub '>First<\/label>\n                                                <\/span>\n                            \n                            <span id='input_1_14_6_container' class='name_last gform-grid-col gform-grid-col--size-auto' >\n                                                    <input type='text' name='input_14.6' id='input_1_14_6' value=''   aria-required='true'     \/>\n                                                    <label for='input_1_14_6' class='gform-field-label gform-field-label--type-sub '>Last<\/label>\n                                                <\/span>\n                            \n                        <\/div><\/li><li id=\"field_1_15\" class=\"gfield gfield--type-email gf_left_half gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_1_15'><span class='gform-field-label__text'>Referring Contact Email<\/span><span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_email'>\n                            <input name='input_15' id='input_1_15' type='email' value='' class='medium'    aria-required=\"true\" aria-invalid=\"false\"  \/>\n                        <\/div><\/li><li id=\"field_1_16\" class=\"gfield gfield--type-phone gfield--phone-format-standard gf_right_half field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_1_16'><span class='gform-field-label__text'>Referring Contact Phone<\/span><\/label><div class='ginput_container ginput_container_phone'><input name='input_16' id='input_1_16' type='tel' value='' class='medium'  placeholder='(999) 999-9999'  aria-invalid=\"false\"   data-mask=\"(999) 999-9999\" \/><\/div><\/li><li id=\"field_1_6\" class=\"gfield gfield--type-text field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_1_6'><span class='gform-field-label__text'>Other Reason<\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_6' id='input_1_6' type='text' value='' class='large'      aria-invalid=\"false\"   \/><\/div><\/li><li id=\"field_1_7\" class=\"gfield gfield--type-textarea field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_1_7'><span class='gform-field-label__text'>Comments\/Questions<\/span><\/label><div class='ginput_container ginput_container_textarea'><textarea name='input_7' id='input_1_7' class='textarea medium'      aria-invalid=\"false\"   rows='10' cols='50'><\/textarea><\/div><\/li><li id=\"field_1_8\" class=\"gfield gfield--type-checkbox gfield--type-choice field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible gfield--choice-align-vertical\"  ><label class='gfield_label gform-field-label gfield_label_before_complex' ><span class='gform-field-label__text'>May we add you to our Quarterly Newsletter?<\/span><\/label><div class='ginput_container ginput_container_checkbox'><ul class='gfield_checkbox' id='input_1_8'><li class='gchoice gchoice_1_8_1'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_8.1' type='checkbox'  value='yes'  id='choice_1_8_1'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_1_8_1' id='label_1_8_1' class='gform-field-label gform-field-label--type-inline'>yes<\/label>\n\t\t\t\t\t\t\t<\/li><\/ul><\/div><\/li><li id=\"field_1_9\" class=\"gfield gfield--type-html gfield_html gfield_html_formatted gfield_no_follows_desc field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  >&nbsp;<p style=\"font-size: 12px;\">By providing your contact information, you are authorizing us (Young Caregivers Association) to contact you, using the information submitted as reference for communications. Submitted information is regarded as confidential and private, and will be treated with professional care and attention.<\/p><\/li><\/ul><\/div>\n        <div class='gform-footer gform_footer top_label'> <button type='submit' id='gform_submit_button_1' class='gform_button button' onclick='gform.submission.handleButtonClick(this);' data-submission-type='submit' >Submit<\/button> \n            <input type='hidden' class='gform_hidden' name='gform_submission_method' data-js='gform_submission_method_1' value='postback' \/>\n            <input type='hidden' class='gform_hidden' name='gform_theme' data-js='gform_theme_1' id='gform_theme_1' value='legacy' \/>\n            <input type='hidden' class='gform_hidden' name='gform_style_settings' data-js='gform_style_settings_1' id='gform_style_settings_1' value='[]' \/>\n            <input type='hidden' class='gform_hidden' name='is_submit_1' value='1' \/>\n            <input type='hidden' class='gform_hidden' name='gform_submit' value='1' \/>\n            \n            <input type='hidden' class='gform_hidden' name='gform_currency' data-currency='CAD' value='pdFJEjzfdrxgViNXlwv6mSUHWP86VeOg+T0\/LK447y1SPv2oncNxv4wNbGY2c48ZcooXP\/eH+WTJV8CMo7atCqvX84ioj3Og0TBLJJf6jAB0aKA=' \/>\n            <input type='hidden' class='gform_hidden' name='gform_unique_id' value='' \/>\n            <input type='hidden' class='gform_hidden' name='state_1' value='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' \/>\n            <input type='hidden' autocomplete='off' class='gform_hidden' name='gform_target_page_number_1' id='gform_target_page_number_1' value='0' \/>\n            <input type='hidden' autocomplete='off' class='gform_hidden' name='gform_source_page_number_1' id='gform_source_page_number_1' value='1' \/>\n            <input type='hidden' name='gform_field_values' value='' \/>\n            \n        <\/div>\n                        <\/form>\n                        <\/div>\n<p>[\/et_pb_text][\/et_pb_column][\/et_pb_row][et_pb_row column_structure=&#8221;1_2,1_2&#8243; make_equal=&#8221;on&#8221; _builder_version=&#8221;4.21.0&#8243; global_colors_info=&#8221;{}&#8221;][et_pb_column type=&#8221;1_2&#8243; _builder_version=&#8221;4.16&#8243; custom_padding=&#8221;|5px||5px|false|true&#8221; custom_padding_tablet=&#8221;|0px||0px|false|true&#8221; custom_padding_phone=&#8221;&#8221; custom_padding_last_edited=&#8221;on|tablet&#8221; border_width_right=&#8221;1px&#8221; border_color_right=&#8221;#aaaaaa&#8221; border_width_right_tablet=&#8221;0px&#8221; border_width_right_phone=&#8221;0px&#8221; border_width_right_last_edited=&#8221;on|tablet&#8221; global_colors_info=&#8221;{}&#8221;][et_pb_text _builder_version=&#8221;4.16&#8243; header_2_font_size=&#8221;32px&#8221; global_colors_info=&#8221;{}&#8221;]<\/p>\n<h2>Head Office\/Niagara centre<\/h2>\n<p>318 Ontario St<br \/>Unit 7A<br \/>St. Catharines, ON\u00a0 L2R 5L8<br \/>Fax: 289-362-2342<\/p>\n<p>[\/et_pb_text][et_pb_text _builder_version=&#8221;4.16&#8243; header_2_font_size=&#8221;32px&#8221; width=&#8221;93.9%&#8221; global_colors_info=&#8221;{}&#8221;]<\/p>\n<h2>Haldimand-Norfolk HAMILTON BRANT Centre<\/h2>\n<p>c\/o Haldimand Abilities Centre<br \/>42 Main St. South<br \/>Hagersville, ON\u00a0 N0A 1H0<br \/>Fax: 905-768-1034<\/p>\n<p>[\/et_pb_text][et_pb_map address=&#8221;Smithville, ON L0R, Canada&#8221; zoom_level=&#8221;8&#8243; address_lat=&#8221;43.0956545&#8243; address_lng=&#8221;-79.5494234&#8243; mouse_wheel=&#8221;off&#8221; mobile_dragging=&#8221;off&#8221; use_grayscale_filter=&#8221;on&#8221; grayscale_filter_amount=&#8221;100&#8243; _builder_version=&#8221;4.21.0&#8243; width=&#8221;84.9%&#8221; custom_padding=&#8221;|||0px||&#8221; global_colors_info=&#8221;{}&#8221;][et_pb_map_pin title=&#8221;Niagara Centre&#8221; pin_address=&#8221;318 Ontario St, St. Catharines, ON L2R 5L8, Canada&#8221; pin_address_lat=&#8221;43.1696945&#8243; pin_address_lng=&#8221;-79.2637096&#8243; _builder_version=&#8221;3.29.3&#8243; global_colors_info=&#8221;{}&#8221;]<\/p>\n<p>318 Ontario St<br \/> Unit 7A<br \/> St. Catherines ON \u00a0L2R 5L8<br \/> Ph: 905-932-4201<br \/> Fx: 289-362-2342<\/p>\n<p>[\/et_pb_map_pin][et_pb_map_pin title=&#8221;Haldimand-Norfolk Centre&#8221; pin_address=&#8221;42 Main St S, Hagersville, ON N0A 1H0, Canada&#8221; pin_address_lat=&#8221;42.9602509&#8243; pin_address_lng=&#8221;-80.0536515&#8243; _builder_version=&#8221;3.29.3&#8243; global_colors_info=&#8221;{}&#8221;]<\/p>\n<p>c\/o Haldimand Abilities Centre<br \/> 42 Main St.<br \/> Hagersville, ON \u00a0N0A 2H0<br \/> Ph: \u00a0905-768-1034<br \/> Fx: \u00a0905-768-1034<\/p>\n<p>[\/et_pb_map_pin][\/et_pb_map][\/et_pb_column][et_pb_column type=&#8221;1_2&#8243; _builder_version=&#8221;4.16&#8243; custom_padding=&#8221;|5px||5px|false|true&#8221; custom_padding_tablet=&#8221;|0px||0px|false|true&#8221; custom_padding_phone=&#8221;&#8221; custom_padding_last_edited=&#8221;on|tablet&#8221; border_width_right=&#8221;1px&#8221; border_color_right=&#8221;#aaaaaa&#8221; border_width_right_tablet=&#8221;0px&#8221; border_width_right_phone=&#8221;0px&#8221; border_width_right_last_edited=&#8221;on|tablet&#8221; global_colors_info=&#8221;{}&#8221;][et_pb_text _builder_version=&#8221;4.21.0&#8243; header_2_font_size=&#8221;32px&#8221; width=&#8221;89.3%&#8221; custom_margin=&#8221;0px|0px|0px|0px|false|false&#8221; custom_padding=&#8221;0px|0px|0px|0px|false|false&#8221; global_colors_info=&#8221;{}&#8221;]<\/p>\n<h2><span>For more information on Young Caregiver Training for professionals or Programs in Partnership contact our Strategic Partnerships &amp; Community Outreach Manager:<\/span><\/h2>\n<p>[\/et_pb_text][et_pb_text _builder_version=&#8221;4.21.0&#8243; header_2_font_size=&#8221;32px&#8221; global_colors_info=&#8221;{}&#8221;]<\/p>\n<p><strong>Chrissy Sadowski<\/strong><br \/>Strategic Partnerships &amp; Community Outreach Manager<br \/>P: 905 708 4367 <br \/>E: chrissys@youngcaregivers.ca<\/p>\n<p>[\/et_pb_text][et_pb_text _builder_version=&#8221;4.16&#8243; header_2_font_size=&#8221;32px&#8221; width=&#8221;89.3%&#8221; custom_margin=&#8221;0px|0px|0px|0px|false|false&#8221; custom_padding=&#8221;0px|0px|0px|0px|false|false&#8221; global_colors_info=&#8221;{}&#8221;]<\/p>\n<h2>For more information on programs, how to register your family, or to make a referral contact our Family Navigator:<\/h2>\n<p>[\/et_pb_text][et_pb_text _builder_version=&#8221;4.21.0&#8243; header_2_font_size=&#8221;32px&#8221; global_colors_info=&#8221;{}&#8221;]<\/p>\n<p><strong>Alicia Pinelli<\/strong> <br \/><em>Young Caregiver &amp; Family Counsellor (Niagara &amp; Virtual)<\/em><br \/>P: 905-708-4351<br \/>E: aliciap@youngcaregivers.ca<\/p>\n<p>[\/et_pb_text][et_pb_text _builder_version=&#8221;4.16&#8243; header_2_font_size=&#8221;32px&#8221; width=&#8221;89.3%&#8221; custom_margin=&#8221;0px|0px|0px|0px|false|false&#8221; custom_padding=&#8221;0px|0px|0px|0px|false|false&#8221; global_colors_info=&#8221;{}&#8221;]<\/p>\n<h2><span>For All Other Inquiries:<\/span><\/h2>\n<p>[\/et_pb_text][et_pb_text _builder_version=&#8221;4.21.0&#8243; header_2_font_size=&#8221;32px&#8221; global_colors_info=&#8221;{}&#8221;]<\/p>\n<p><strong>Cayleigh Sexton<\/strong><br \/><i>Executive Director<br \/><\/i>P: 905-708-4347<br \/>E: cayleighs@youngcaregivers.ca<\/p>\n<p>[\/et_pb_text][\/et_pb_column][\/et_pb_row][\/et_pb_section]<\/p>\n","protected":false},"excerpt":{"rendered":"<p>CONTACT US\n                <div class='gf_browser_gecko gform_wrapper gform_legacy_markup_wrapper gform-theme--no-framework' data-form-theme='legacy' data-form-index='0' id='gform_wrapper_1' style='display:none'>\n                        <div class='gform_heading'>\n                            <h3 class=\"gform_title\">Information Request \/ Registration Form<\/h3>\n                            <p class='gform_description'>If you would like more information on Young Caregivers Association\u2122 or our Powerhouse\u2122 program or would like to register, make a referral, become a volunteer, get involved, or request a community presentation, please complete the form below:<\/p>\n                        <\/div><form method='post' enctype='multipart\/form-data'  id='gform_1'  action='\/fr\/wp-json\/wp\/v2\/pages\/4811' data-formid='1' novalidate>\n                        <div class='gform-body gform_body'><ul id='gform_fields_1' class='gform_fields top_label form_sublabel_below description_below validation_below'><li id=\"field_1_17\" class=\"gfield gfield--type-honeypot gform_validation_container field_sublabel_below gfield--has-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_1_17'><span class='gform-field-label__text'>Name<\/span><\/label><div class='ginput_container'><input name='input_17' id='input_1_17' type='text' value='' autocomplete='new-password'\/><\/div><div class='gfield_description' id='gfield_description_1_17'>This field is for validation purposes and should be left unchanged.<\/div><\/li><li id=\"field_1_1\" class=\"gfield gfield--type-name gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label gfield_label_before_complex' ><span class='gform-field-label__text'>Name<\/span><span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_complex ginput_container ginput_container--name no_prefix has_first_name no_middle_name has_last_name no_suffix gf_name_has_2 ginput_container_name gform-grid-row' id='input_1_1'>\n                            \n                            <span id='input_1_1_3_container' class='name_first gform-grid-col gform-grid-col--size-auto' >\n                                                    <input type='text' name='input_1.3' id='input_1_1_3' value=''   aria-required='true'     \/>\n                                                    <label for='input_1_1_3' class='gform-field-label gform-field-label--type-sub '>First<\/label>\n                                                <\/span>\n                            \n                            <span id='input_1_1_6_container' class='name_last gform-grid-col gform-grid-col--size-auto' >\n                                                    <input type='text' name='input_1.6' id='input_1_1_6' value=''   aria-required='true'     \/>\n                                                    <label for='input_1_1_6' class='gform-field-label gform-field-label--type-sub '>Last<\/label>\n                                                <\/span>\n                            \n                        <\/div><\/li><li id=\"field_1_2\" class=\"gfield gfield--type-email gf_left_half gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_1_2'><span class='gform-field-label__text'>Email<\/span><span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_email'>\n                            <input name='input_2' id='input_1_2' type='email' value='' class='medium'    aria-required=\"true\" aria-invalid=\"false\"  \/>\n                        <\/div><\/li><li id=\"field_1_3\" class=\"gfield gfield--type-phone gfield--phone-format-standard gf_right_half field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_1_3'><span class='gform-field-label__text'>Phone<\/span><\/label><div class='ginput_container ginput_container_phone'><input name='input_3' id='input_1_3' type='tel' value='' class='medium'  placeholder='(999) 999-9999'  aria-invalid=\"false\"   data-mask=\"(999) 999-9999\" \/><\/div><\/li><li id=\"field_1_4\" class=\"gfield gfield--type-select field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_1_4'><span class='gform-field-label__text'>Location<\/span><\/label><div class='ginput_container ginput_container_select'><select name='input_4' id='input_1_4' class='large gfield_select'     aria-invalid=\"false\" ><option value='Niagara' >Niagara<\/option><option value='Haldimand-Norfolk' >Haldimand-Norfolk<\/option><option value='Other (please specify)' >Other (please specify)<\/option><\/select><\/div><\/li><li id=\"field_1_11\" class=\"gfield gfield--type-address field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label gfield_label_before_complex' ><span class='gform-field-label__text'>Other Location<\/span><\/label>    \n                    <div class='ginput_complex ginput_container has_city has_state ginput_container_address gform-grid-row' id='input_1_11' >\n                        <span class='ginput_left address_city ginput_address_city gform-grid-col' id='input_1_11_3_container' >\n                                    <input type='text' name='input_11.3' id='input_1_11_3' value=''    aria-required='false'    \/>\n                                    <label for='input_1_11_3' id='input_1_11_3_label' class='gform-field-label gform-field-label--type-sub '>City<\/label>\n                                 <\/span><span class='ginput_right address_state ginput_address_state gform-grid-col' id='input_1_11_4_container' >\n                                        <input type='text' name='input_11.4' id='input_1_11_4' value=''      aria-required='false'    \/>\n                                        <label for='input_1_11_4' id='input_1_11_4_label' class='gform-field-label gform-field-label--type-sub '>State \/ Province \/ Region<\/label>\n                                      <\/span><input type='hidden' class='gform_hidden' name='input_11.6' id='input_1_11_6' value='' \/>\n                    <div class='gf_clear gf_clear_complex'><\/div>\n                <\/div><\/li><li id=\"field_1_5\" class=\"gfield gfield--type-checkbox gfield--type-choice gf_list_2col field_sublabel_below gfield--has-description field_description_above field_validation_below gfield_visibility_visible gfield--choice-align-vertical\"  ><label class='gfield_label gform-field-label gfield_label_before_complex' ><span class='gform-field-label__text'>Reason for contact<\/span><\/label><div class='gfield_description' id='gfield_description_1_5'>check all that apply<\/div><div class='ginput_container ginput_container_checkbox'><ul class='gfield_checkbox' id='input_1_5'><li class='gchoice gchoice_1_5_1'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_5.1' type='checkbox'  value='To register my child\/family'  id='choice_1_5_1'   aria-describedby=\"gfield_description_1_5\"\/>\n\t\t\t\t\t\t\t\t<label for='choice_1_5_1' id='label_1_5_1' class='gform-field-label gform-field-label--type-inline'>To register my child\/family<\/label>\n\t\t\t\t\t\t\t<\/li><li class='gchoice gchoice_1_5_2'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_5.2' type='checkbox'  value='To register myself as a young caregiver'  id='choice_1_5_2'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_1_5_2' id='label_1_5_2' class='gform-field-label gform-field-label--type-inline'>To register myself as a young caregiver<\/label>\n\t\t\t\t\t\t\t<\/li><li class='gchoice gchoice_1_5_3'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_5.3' type='checkbox'  value='To refer a young caregiver\/family'  id='choice_1_5_3'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_1_5_3' id='label_1_5_3' class='gform-field-label gform-field-label--type-inline'>To refer a young caregiver\/family<\/label>\n\t\t\t\t\t\t\t<\/li><li class='gchoice gchoice_1_5_4'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_5.4' type='checkbox'  value='To receive information about services'  id='choice_1_5_4'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_1_5_4' id='label_1_5_4' class='gform-field-label gform-field-label--type-inline'>To receive information about services<\/label>\n\t\t\t\t\t\t\t<\/li><li class='gchoice gchoice_1_5_5'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_5.5' type='checkbox'  value='To request a presentation'  id='choice_1_5_5'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_1_5_5' id='label_1_5_5' class='gform-field-label gform-field-label--type-inline'>To request a presentation<\/label>\n\t\t\t\t\t\t\t<\/li><li class='gchoice gchoice_1_5_6'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_5.6' type='checkbox'  value='To become a volunteer'  id='choice_1_5_6'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_1_5_6' id='label_1_5_6' class='gform-field-label gform-field-label--type-inline'>To become a volunteer<\/label>\n\t\t\t\t\t\t\t<\/li><li class='gchoice gchoice_1_5_7'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_5.7' type='checkbox'  value='To join the Board of Directors'  id='choice_1_5_7'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_1_5_7' id='label_1_5_7' class='gform-field-label gform-field-label--type-inline'>To join the Board of Directors<\/label>\n\t\t\t\t\t\t\t<\/li><li class='gchoice gchoice_1_5_8'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_5.8' type='checkbox'  value='Register for an virtual program'  id='choice_1_5_8'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_1_5_8' id='label_1_5_8' class='gform-field-label gform-field-label--type-inline'>Register for an virtual program<\/label>\n\t\t\t\t\t\t\t<\/li><li class='gchoice gchoice_1_5_9'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_5.9' type='checkbox'  value='other (please specify)'  id='choice_1_5_9'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_1_5_9' id='label_1_5_9' class='gform-field-label gform-field-label--type-inline'>other (please specify)<\/label>\n\t\t\t\t\t\t\t<\/li><\/ul><\/div><\/li><li id=\"field_1_12\" class=\"gfield gfield--type-text gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_1_12'><span class='gform-field-label__text'>Referring Agency<\/span><span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_12' id='input_1_12' type='text' value='' class='large'     aria-required=\"true\" aria-invalid=\"false\"   \/><\/div><\/li><li id=\"field_1_14\" class=\"gfield gfield--type-name gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label gfield_label_before_complex' ><span class='gform-field-label__text'>Referring Contact<\/span><span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_complex ginput_container ginput_container--name no_prefix has_first_name no_middle_name has_last_name no_suffix gf_name_has_2 ginput_container_name gform-grid-row' id='input_1_14'>\n                            \n                            <span id='input_1_14_3_container' class='name_first gform-grid-col gform-grid-col--size-auto' >\n                                                    <input type='text' name='input_14.3' id='input_1_14_3' value=''   aria-required='true'     \/>\n                                                    <label for='input_1_14_3' class='gform-field-label gform-field-label--type-sub '>First<\/label>\n                                                <\/span>\n                            \n                            <span id='input_1_14_6_container' class='name_last gform-grid-col gform-grid-col--size-auto' >\n                                                    <input type='text' name='input_14.6' id='input_1_14_6' value=''   aria-required='true'     \/>\n                                                    <label for='input_1_14_6' class='gform-field-label gform-field-label--type-sub '>Last<\/label>\n                                                <\/span>\n                            \n                        <\/div><\/li><li id=\"field_1_15\" class=\"gfield gfield--type-email gf_left_half gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_1_15'><span class='gform-field-label__text'>Referring Contact Email<\/span><span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_email'>\n                            <input name='input_15' id='input_1_15' type='email' value='' class='medium'    aria-required=\"true\" aria-invalid=\"false\"  \/>\n                        <\/div><\/li><li id=\"field_1_16\" class=\"gfield gfield--type-phone gfield--phone-format-standard gf_right_half field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_1_16'><span class='gform-field-label__text'>Referring Contact Phone<\/span><\/label><div class='ginput_container ginput_container_phone'><input name='input_16' id='input_1_16' type='tel' value='' class='medium'  placeholder='(999) 999-9999'  aria-invalid=\"false\"   data-mask=\"(999) 999-9999\" \/><\/div><\/li><li id=\"field_1_6\" class=\"gfield gfield--type-text field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_1_6'><span class='gform-field-label__text'>Other Reason<\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_6' id='input_1_6' type='text' value='' class='large'      aria-invalid=\"false\"   \/><\/div><\/li><li id=\"field_1_7\" class=\"gfield gfield--type-textarea field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_1_7'><span class='gform-field-label__text'>Comments\/Questions<\/span><\/label><div class='ginput_container ginput_container_textarea'><textarea name='input_7' id='input_1_7' class='textarea medium'      aria-invalid=\"false\"   rows='10' cols='50'><\/textarea><\/div><\/li><li id=\"field_1_8\" class=\"gfield gfield--type-checkbox gfield--type-choice field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible gfield--choice-align-vertical\"  ><label class='gfield_label gform-field-label gfield_label_before_complex' ><span class='gform-field-label__text'>May we add you to our Quarterly Newsletter?<\/span><\/label><div class='ginput_container ginput_container_checkbox'><ul class='gfield_checkbox' id='input_1_8'><li class='gchoice gchoice_1_8_1'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_8.1' type='checkbox'  value='yes'  id='choice_1_8_1'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_1_8_1' id='label_1_8_1' class='gform-field-label gform-field-label--type-inline'>yes<\/label>\n\t\t\t\t\t\t\t<\/li><\/ul><\/div><\/li><li id=\"field_1_9\" class=\"gfield gfield--type-html gfield_html gfield_html_formatted gfield_no_follows_desc field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  >&nbsp;<p style=\"font-size: 12px;\">By providing your contact information, you are authorizing us (Young Caregivers Association) to contact you, using the information submitted as reference for communications. Submitted information is regarded as confidential and private, and will be treated with professional care and attention.<\/p><\/li><\/ul><\/div>\n        <div class='gform-footer gform_footer top_label'> <button type='submit' id='gform_submit_button_1' class='gform_button button' onclick='gform.submission.handleButtonClick(this);' data-submission-type='submit' >Submit<\/button> \n            <input type='hidden' class='gform_hidden' name='gform_submission_method' data-js='gform_submission_method_1' value='postback' \/>\n            <input type='hidden' class='gform_hidden' name='gform_theme' data-js='gform_theme_1' id='gform_theme_1' value='legacy' \/>\n            <input type='hidden' class='gform_hidden' name='gform_style_settings' data-js='gform_style_settings_1' id='gform_style_settings_1' value='[]' \/>\n            <input type='hidden' class='gform_hidden' name='is_submit_1' value='1' \/>\n            <input type='hidden' class='gform_hidden' name='gform_submit' value='1' \/>\n            \n            <input type='hidden' class='gform_hidden' name='gform_currency' data-currency='CAD' value='B1y0UGZQwVsqlXRSE12ujCRX7REB+1tDIVnub+qURQncRICXjHqBn2ziaqaW\/lsU1bS\/oTcItWsGQa98Fmxj9Eln9bOBPztsJP23GGS16Tv092s=' \/>\n            <input type='hidden' class='gform_hidden' name='gform_unique_id' value='' \/>\n            <input type='hidden' class='gform_hidden' name='state_1' value='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' \/>\n            <input type='hidden' autocomplete='off' class='gform_hidden' name='gform_target_page_number_1' id='gform_target_page_number_1' value='0' \/>\n            <input type='hidden' autocomplete='off' class='gform_hidden' name='gform_source_page_number_1' id='gform_source_page_number_1' value='1' \/>\n            <input type='hidden' name='gform_field_values' value='' \/>\n            \n        <\/div>\n                        <\/form>\n                        <\/div>Head Office\/Niagara centre 318 Ontario StUnit 7ASt. Catharines, ON\u00a0 L2R 5L8Fax: 289-362-2342 Haldimand-Norfolk HAMILTON BRANT Centre c\/o Haldimand Abilities Centre42 Main St. SouthHagersville, ON\u00a0 N0A 1H0Fax: 905-768-1034 318 Ontario St Unit 7A St. Catherines ON \u00a0L2R 5L8 Ph: 905-932-4201 Fx: 289-362-2342c\/o Haldimand Abilities Centre 42 Main St. Hagersville, ON \u00a0N0A 2H0 Ph: \u00a0905-768-1034 [&hellip;]<\/p>\n","protected":false},"author":5,"featured_media":0,"parent":0,"menu_order":0,"comment_status":"closed","ping_status":"closed","template":"","meta":{"_et_pb_use_builder":"on","_et_pb_old_content":"<!-- wp:divi\/placeholder \/-->","_et_gb_content_width":"","footnotes":""},"class_list":["post-4811","page","type-page","status-publish","hentry"],"yoast_head":"<!-- This site is optimized with the Yoast SEO plugin v28.4 - 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