Wellspring Edmonton

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Become a Member

Please fill out the form below. Membership is free for everyone at Wellspring Edmonton.

Information provided is for internal use only, such as registering for a course or booking an appointment.

This centre will be your home Wellspring centre but you may also attend programs at other centres. If you would like to choose a different home centre, you may select a location.

Date of Birth
You are registering with Wellspring because you are: (check all that apply)

Your Home Address

Emergency Contact Information:

If you are a cancer patient, please answer the following questions about your diagnosis.

If you are a caregiver of a cancer patient, please answer the following questions about the diagnosis of the person for whom you are caring.

Sometimes, people come to Wellspring who have cancer, and are also caring for a friend or family member with cancer. If this applies to you, please complete the following information based on your diagnosis.

Primary type(s) of cancer:
Is the cancer metastatic?

Metastatic cancer, also known as mets, is cancer that has spread from the primary cancer site to other parts of the body.

Please choose the sentence below that best describes the current status of the diagnosis:

If applicable

You are registering at Wellspring because of the loss of a:

Wellspring supports the entire family, and has specialized programming for families with young children. In order for Wellspring to anticipate demand to grow these programs, and to let you know of new programs as they are developed, we are asking to know the number, and ages, of young children you have. No other information about your children is being requested.

Your child, or any of their siblings, under the age of 18 may also come to Wellspring programs (e.g. childcare, programs for children). If you would like to register them, please provide the following information:

Child's date of birth:

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