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 Province Postal code
Telephone*
Telephone extension
Choose your Leucan regional office*
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: