New Therapist Request Form
Thank you for your interest in Badge of Life Canada and your request to be added to the list of therapists on our website.
Complete and submit the form so your information can be reviewed.
If you are approved, your listing will be added to our website and you will be notified, via email, when it is completed and “live”.
By sending this form, you agree to be added to our Newsletter mailing list.
The questions with an “asterisk” are required. The form cannot be submitted unless all “required” questions are answered. If you have any question(s), please contact the Executive Director Laura Kloosterman via our “Contact Us” form.
(a new tab will open so you do not lose the information in the current tab).
Our charity is entirely funded by donations. Even though not required to get your information listed,
any donation you make goes directly to the mission and programs we offer. Donation receipts are issued by Canada Helps.