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CBS Registration

Please fill out the following forms to complete your profile with Community Based Services.

Note: All information is confidential and collected according to BC Personal Information Protection Act (PIPA) guidelines. Refer to the NSDRC Privacy Policy for more information.

804A Community Based Services Registration
Program *
Please select the program(s) you are registering into
Please provide the name of the CLBC facilitator or MCFD Social Worker if known.

Participant Profile Information

Participant - This is a mobile number
Participant Address *
Participant Address
City
State/Province
Zip/Postal

Primary Contact Information

Primary Contact - This is a mobile number
If no email address, please enter none@none.org.
I consent to the NSDRC contacting me through this email address for all program related information. *
I may withdraw this consent at any time.
Primary Contact Address *
Primary Contact Address
Primary Contact Address
City
State/Province
Zip/Postal

Secondary Contact Information

Secondary Contact - This is a mobile number
Secondary Contact Address
Address
Address
City
State/Province
Zip/Postal
Country

Emergency Contact Information

Emergency Contact - This is a mobile number
Emergency Contact Address
Emergency Contact Address
City
State/Province
Zip/Postal
Country

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Each of us has a role to play in creating the community we want to live, work and play in. Join our email list to keep up to date on NSDRC news. Let's build a better community together!

North Shore Disability Resource Centre

3158 Mountain Highway

North Vancouver, BC

V7K 2H5

phone: 604-985-5371

fax: 604-985-7594

email: nsdrc@nsdrc.org

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United Way member agency

The NSDRC was started by a group of families in 1976. In the years since, we have worked for a "Community for All" by developing and providing community housing, infant development programs, youth groups, community-based services, and information and advocacy.

We are grateful for the opportunity to work, live and play on the unceded territory of the Coast Salish Peoples, including the territories of Musqueam, Squamish, and Tsleil-Waututh Nations.

NSDRC

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