2. 
4. REGISTRATION FORM

   Please enter your information in the fields below to register for our Transitioning to Parenthood Workshop on Tuesday, May 10th from 6:30 - 8:30pm.

6. First Name*
7. Last Name*
9. Phone Number*
10. Email Address*
12. City or Town of Residence*
13. Postal Code*
15. I will be attending this workshop as a*

    Please select those that apply

    1. Parent
    2. Caregiver
    3. Step Parent
    4. Foster Parent
    5. Grandparent
    6. Other
16. How many children do you have in your care?*
17. What are the ages of your children?*

    For example 6 months, and 8 yrs

19. Will someone be joining you for this workshop?*

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

    For example husband, wife or parenting partner

22. Please list any specific topics or questions that would you like our presenter to address.

    Please be specific

26. How did you hear 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
28. If you selected 'other' please let us know how you heard about the workshop.
30. 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.
32. PLEASE NOTE

    We do not send a confirmation email. Instead, you will receive an email with the WebEx link to join,  24 - 48 hours before the scheduled session. We also include instructions on how to use WebEx, how to download it, etc.

34. 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!

36. 
38. 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:


40. 1. Receive an email copy of this form.
41. Email address

    This field is not part of the form submission.

42. Submit

* indicates a required field