Grow & Learn Registration Form

2. 
4. WELCOME
   <p fr-original-style="" style="margin: 0px 0px 1.4em; box-sizing: inherit; border: 0px none; font-family: Arial; font-style: normal; font-weight: 400; color: rgb(65, 64, 66); line-height: 1.4;">Please <span fr-original-style="color: rgb(65, 64, 66); font-family: Arial; font-size: 12.96px; font-style: normal; font-variant-ligatures: normal; font-variant-caps: normal; font-weight: 400; letter-spacing: normal; orphans: 2; text-align: left; text-indent: 0px; text-transform: none; white-space: normal; widows: 2; word-spacing: 0px; -webkit-text-stroke-width: 0px; background-color: rgb(255, 255, 255); text-decoration-thickness: initial; text-decoration-style: initial; text-decoration-color: initial; display: inline !important; float: none;" style="color: rgb(65, 64, 66); font-family: Arial; font-size: 12.96px; font-style: normal; font-variant-ligatures: normal; font-variant-caps: normal; font-weight: 400; letter-spacing: normal; orphans: 2; text-align: left; text-indent: 0px; text-transform: none; white-space: normal; widows: 2; word-spacing: 0px; -webkit-text-stroke-width: 0px; background-color: rgb(255, 255, 255); text-decoration-thickness: initial; text-decoration-style: initial; text-decoration-color: initial; float: none; display: inline !important; box-sizing: inherit;">enter your information in the fields below to</span> register for our Grow &amp; Learn session(s) we are offering in June.</p>

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

6. Which session(s) would you like to register for?*

   Please select those that apply

   1. Grow & Learn with Camp Chestermere (June 14th from 7:00-8:00 PM)
   2. Grow & Learn with Children's Link (June 17 from 7:00-8:30 PM)
7. 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
9. First Name*
10. Last Name*
12. Phone Number*
13. Email Address*
15. City or Town of Residence*
16. Postal Code*
18. How many children/youth do you have in your care?*
19. Please provide their age(s)*

    For example 6 months, and 8 yrs

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

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

    For example husband, wife or parenting partner

24. Does your child or youth currently have a contract through Family Support for Children with Disabilities (FSCD)?*

    Please select those that apply

    1. Yes
    2. No
    3. Not sure
26. Do you have any specific questions or topics that you would like addressed?
30. 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
32. 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.
34. Connecting to our ONLINE Grow & Learn session(s)
    <p fr-original-style="" style="margin: 0px 0px 1.4em; box-sizing: inherit; border: 0px none; font-family: Arial; font-style: normal; font-weight: 400; color: rgb(65, 64, 66); line-height: 1.4;">You will receive an email 24 - 48 hours before the Grow &amp; Learn session that will include a link as well as instructions about how to join online using the Microsoft Teams application.</p>

    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.

36. 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!

38. 
40. 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.

    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:


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