Connections Place is a Clubhouse model program accredited by Clubhouse International. We offer hope, encouragement and opportunities to people who live with mental illness. We provide a supportive environment that encourages participation and a sense of belonging, with a focus on individual strengths and talents, rather than illness.


Please complete this application form if you are interested in becoming a Connections Place member. Once you complete the form, click the submit button at the bottom.


Member Information


Health/Medical Contact Information


Family/Community Contact Information


Emergency Contact Information


Safety Information

To qualify for membership you must have a past or present primary diagnosis of mental illness. In order to maintain a safe environment, we are not able to offer membership to those who have a recent history of violent or aggressive behaviour. However, a history of violence does not necessarily mean you are not eligible for membership.


Income Information


Housing Information


Medical Conditions and/or Allergies


Medications


Clubhouse Services

The Clubhouse offers services to assist you in reaching your goals and supporting your recovery process. What interests you in becoming a member? Place a tick beside the option(s) that interest you.


Children under 18


Informed Consent

I understand that a history of violence does not necessarily mean I am not eligible for membership. I understand that my application is subject to Connections Place's Privacy Policy (available from our office upon request).