Triple P Registration Form

2. 
4. Registration Form

   Please provide your information in the fields below to register for our Have a Successful Summer Parenting Workshop (June 29 from 9:30 - 11:00am). The registration deadline is June 25. 

6. First Name*
7. Last Name*
9. Phone Number*
10. Email Address*
12. City or Town of Residence*
13. Postal Code*
15. Workshop Package(s) & Materials

    Each workshop includes a resource package with various handouts for parents. Please note that you will receive an email within 1-2 business days with instructions on when and where to pick up your workshop package(s).

    For the Have a Successful Summer Workshop parents will receive a workbook and resources.

19. I will be attending the workshop(s) as a:*

    Please select those that apply

    1. Parent
    2. Caregiver
    3. Step Parent
    4. Foster Parent
    5. Grandparent
    6. Other
20. Will someone else be joining you for this workshop?*

    1. Yes
    2. No
21. If yes, what is their relationship to you?
    For example a spouse, parenting partner, friend, or another family member.
23. Are there any specific topics that you would like us to focus on during the workshop?
27. Family Demographics
    The information collected in this section is used to report back to our funders. Any question with an asterisk (*) is mandatory to complete.
29. Were you born in Canada?*

    1. Yes
    2. No
30. If you were born in Canada are you:

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

    1. Yes
    2. No
32. If you have lived in Canada for less than 3 years, where did you live before moving here?
34. Total Number of Children or Youth *
    Please tell us how many children or youth that you care for.
35. Were your children or youth*

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

    1. Indigenous
    2. Francophone
    3. None of the above
37. If not born in Canada, have any been in Canada less than 3 years?

    1. Yes
    2. No
39. If applicable, how many have been in the country less than 3 years?
40. Date of Birth (1st Child)*
    Date of Birth (1st Child)
41. Date of Birth (2nd Child)
    Date of Birth (2nd Child)
43. Date of Birth (3rd Child)
    Date of Birth (3rd Child)
44. Date of Birth (4th Child)
    Date of Birth (4th Child)
48. How did you learn about this workshop?*

    1. Facebook Page
    2. City Website
    3. Friend or family member
    4. I was referred or told by an agency or service provider
    5. Other
49. If you were referred by an agency or service provider, please provide their name.
    E.g. Synergy, FCSS, Chestermere/Strathmore FRN Hub, Healthy Families, etc.
51. You will receive an email 24 - 48 hours BEFORE each workshop that will include a link as well as instructions about how to join online using the WebEx application. If you do not see the email, please check your Junk Mail.
53. 
55. Freedom of Information & Privacy (FOIP)
    The 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.
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57. 1. Receive an email copy of this form.
58. Email address

    This field is not part of the form submission.

59. Submit