Grow & Learn Registration Form

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4. Grow & Learn Registration Form
   To register, please provide your information in the fields below. If you have any questions about this form or having difficulty completing it, please call or email us at (403) 207-7050 or pcssinfo@chestermere.ca

   To register, please provide your information in the fields below. If you have any questions about this form or having difficulty completing it, please call or email us at (403) 207-7050 or pcssinfo@chestermere.ca

6. First Name*

7. Last Name*

9. Will another adult be attending the session with you?

   If yes, please provide their name

11. Phone Number*

12. Email Address*

14. City or Town of Residence*

15. Postal Code*

17. Please Note:
    You will receive an email 24-48 hours prior to the session with instructions on how to connect to our virtual check-in. The City of Chestermere uses a secure virtual conferencing tool called WebEx to host any meetings, workshops, and programs. Please note that you are not required to download any software to participate in the workshop. You will be able join by simply clicking on the meeting link that will be sent to you.

    You will receive an email 24-48 hours prior to the session with instructions on how to connect to our virtual check-in. The City of Chestermere uses a secure virtual conferencing tool called WebEx to host any meetings, workshops, and programs. Please note that you are not required to download any software to participate in the workshop. You will be able join by simply clicking on the meeting link that will be sent to you.

19. I am attending the Program as a*

    Please select those that apply

    1. Parent
    2. Caregiver
    3. Step Parent
    4. Foster Parent
    5. Grandparent
    6. Other
20. Total Number of Children*

    Please tell us how many children are in your household or for whom you are a regular caregiver for

21. Age of Each Child*

    Age of each child, separated by a comma (e.g. 2, 5, and 12 years)

23. Please Note:
    The Wellness Activity Kits are in limited supply. First priority will be given to Chestermere residents.

    The Wellness Activity Kits are in limited supply. First priority will be given to Chestermere residents.

25. I would like to register for the following sessions:*

    Please select all that apply

    1. Wellness Activity Kits: December 16th from 6:30-7:30p.m.
27. Please indicate which date/time would be most convenient for you to pickup your kit? (Pickup will be in Chestermere only).*
    -- Select One --Friday December 11 (daytime)Monday December 14 (evening)Neither of these days/times work for me

    You will receive an email with more information on the pickup process, including times and locations.

29. How did you find out about this Grow & Learn session?*

    Please tell us how you found out about the workshop so we can use this information to plan for future programs and workshops

31. Monthly PCSS Newsletter*

    1. Yes Please
    2. No Thank You

    Would you like to be added to our monthly email distribution list to learn about programs, resources, and the latest news from the Parent & Caregiver Support Services team?

33. Thank you for registering for Grow & Learn! We look forward to connecting with you virtually!

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40. FOIP
    <i>The personal information is being collected for activities related to applying for, creating, distributing, and tracking permits for the City of Chestermere, 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 the Municipal Office, 105 Marina Road, Chestermere, AB T1X 1V7 or call 403-207-7050 </i>

    The personal information is being collected for activities related to applying for, creating, distributing, and tracking permits for the City of Chestermere, 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 the Municipal Office, 105 Marina Road, Chestermere, AB T1X 1V7 or call 403-207-7050

Leave This Blank:


42. 1. Receive an email copy of this form.
43. Email address

    This field is not part of the form submission.

44. Submit

* indicates a required field