KHST Registration Form

2. 
4. Kids Have Stress Too Parent Workshop(s)
   To register for this workshop please provide your information in the fields below. Please note that all information is kept strictly confidential.
5. 
7. Please select which session(s) you would like to register for:*

   You may register for both, please select all that apply.

   1. Grade 1-6 (March 13 at 10:00a.m.-12:00 p.m)
   2. Grade 7-12 (March 13 at 1:00-3:00 p.m.)
8. DETAILS
   Click here for poster

   To view workshop descriptions, dates/times, and details please click on the link above.
10. First Name*
11. Last Name*
13. Will someone else from your family be attending the workshop with you?
    If yes, please provide their name
14. I am attending the Workshop as a*

    Please select those that apply:

    1. Parent
    2. Caregiver
    3. Step Parent
    4. Foster Parent
    5. Grandparent
    6. Other
16. Phone Number*
17. Email Address*
19. City or Town of Residence*
20. Postal Code
22. Total number of children or youth*
    Please tell us how many children or youth you care for.
23. Date of Birth (1st Child)*
    Date of Birth (1st Child)
24. Date of Birth (2nd Child)
    Date of Birth (2nd Child)
25. Date of Birth (3rd Child)
    Date of Birth (3rd Child)
27. Date of Birth (4th Child)
    Date of Birth (4th Child)
31. Family Demographics Section
    The information collected in this section is captured for our funder to help with reporting purposes. All information you provide in this form is kept strictly confidential.
33. Were you born in Canada?*

    1. Yes
    2. No
34. If you were born in Canada, are you:*

    1. Indigenous
    2. Francophone
    3. None of the Above
35. If you were NOT born in Canada, have you lived here for less than 3 years?

    1. Yes
    2. No
36. If you have lived in Canada for less than 3 years, where did you live before moving here?
38. Were your children or youth:*

    1. Born in Canada
    2. Born outside of Canada
    3. Born in Canada and outside of Canada
39. If born in Canada, are your children or youth:

    1. Indigenous
    2. Francophone
    3. None of the Above
43. How did you find out about this workshop?*

    1. Facebook Page
    2. City Website
    3. Friend or family member
    4. I was referred by or told by an agency/service provider
    5. Other
44. If you were referred by an agency or service provider, please indicate which one.
    For example Synergy, FCSS, Chestermere/Strathmore FRN Hub, Healthy Families, etc.
48. Workshop Materials & Resource Package
    A series of workshop handouts and recommended resources will be assembled for each parent/caregiver. Packages will be available for you to pick up starting on Monday, March 1st at Camp Chestermere (They are located at 1041 E Lakeview Rd, Chestermere, AB in Kinniburgh). Their hours of operation are Monday to Friday, 9:00am - 5:00pm. Packages will need to be picked up between Wednesday, March 3rd and Friday, March 12th.
50. Pick-Up Instructions
    Once you arrive at Camp Chestermere please go directly to their front door and dial the number that is posted on the door. Once you connect with one of their staff members, you can let them know that you are picking up your workshop package for "Kids Have Stress Too" making sure you indicate which session you're attending (grades 1-6 OR grades 7-12).
52. Need to Coordinate a Different Pick-Up Time?
    Please email the Camp Director, Shannon Dean, to coordinate a different time by emailing him at campdirector@campchestermere.com
56. Thank you for registering for our workshop! We look forward to connecting with you virtually!
58. 
59. 
60. 
63. Freedom of Information & Privacy (FOIP)
    Your personal information is being collected for activities related to the Parent & Caregiver Support Services (PCSS) program, workshop, seminar, and/or group activity and as such is deemed to be an activity of the City of Chestermere. The personal information is collected under the authority of Section 33(1)c of the Freedom of Information and Protection of Privacy Act, and will be used only for the purpose identified. If you have any questions or concerns about the collection or use of information you may contact the FOIP Coordinator at City Hall, 105 Marina Road, Chestermere, AB T1X 1V7 or call (403) 207-7050.
Leave This Blank:


65. 1. Receive an email copy of this form.
66. Email address

    This field is not part of the form submission.

67. Submit