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Preregistration for the 2023 Leucan Halloween Campaign
Preregistration for the 2023 Leucan Halloween Campaign
Complete the form to preregister your school for the 2023 edition of the Leucan Halloween Campaign!
Name of the establishment
*
Address of the establishment
*
Street address
Stress adress line 2
City
Alberta
British Columbia
Manitoba
New Brunswick
Newfoundland and Labrador
Northwest Territories
Nova Scotia
Nunavut
Ontario
Prince Edward Island
Quebec
Saskatchewan
Yukon
Province
Postal code
Telephone
*
Telephone extension
Choose your Leucan regional office
*
Abitibi-Témiscamingue
Bas-Saint-Laurent
Capitale-Nationale
Centre-du-Québec
Chaudière-Appalaches
Côte-Nord
Estrie
Gaspésie–Îles-de-la-Madeleine
Lanaudière
Laurentides
Laval
Mauricie
Montérégie
Montréal
Nord-du-Québec
Outaouais
Saguenay–Lac-Saint-Jean
Name of the contact person at the establishment
*
First name
Last name
Professional title
*
Email
*
Email of the establishment
Has a child or family at your establishment received Leucan's services?
*
Yes
No
I don't know
Name of child:
Siblings: