Grow & Learn Registration Form

2. 
4. WELCOME

   Please enter your information in the fields below to register for our Grow & Learn session(s) we are offering in June.

6. Please select which Grow & Learn session(s) you would like to attend:*

   Please select those that apply

   1. Session 1 (for parents with infants & toddlers 0-3 yrs of age) on THURSDAY, JULY 29TH (9:30 - 11:00 a.m.)
   2. Session 2 (for parents with children 4-7 yrs of age) ON THURSDAY, AUGUST 12th from 9:30 - 11:00 a.m.
8. I will be attending session(s) as a*

   Please select those that apply

   1. Parent
   2. Caregiver
   3. Step Parent
   4. Foster Parent
   5. Grandparent
   6. Other
10. First Name*
11. Last Name*
13. Phone Number*
14. Email Address*
16. City or Town of Residence*
17. Postal Code*
19. How many children do you have in your care?*
20. What are the ages of your children?*

    For example 6 months, and 8 yrs

22. Will someone be joining you for this session?*

    1. Yes, someone else will be attending with me
    2. No, I will be attending alone
23. If yes, what is their relationship to you?

    For example husband, wife or parenting partner

25. Are you concerned about your child's speech and language development?*

    Please select those that apply

    1. Yes
    2. No
27. Please list any specific topics or questions that would you like our presenter to address.

    Please be specific

31. How did you learn about this program or session?*

    1. Facebook Page
    2. City Website
    3. Friend or family member
    4. I was referred or learned about this through an agency or service provider
    5. Other
33. 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.
35. Connecting to our ONLINE Grow & Learn session(s)

    You will receive an email 24 - 48 hours before the Grow & Learn session that will include a link as well as instructions about how to join online using the Microsoft Teams application.

37. Learn more about Parent & Caregiver Support Services (PCSS)
    www.chestermere.ca/pcss

    Click on the link above to visit our website to learn about the services we offer, our upcoming parenting programs and workshops, and how to connect with us!

39. 
41. 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.
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43. 1. Receive an email copy of this form.
44. Email address

    This field is not part of the form submission.

45. Submit

* indicates a required field