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Triple P TEEN Registration Form

REGISTRATION FORM
Please complete our registration form for the Power of Positive Parenting workshop series by filling in your information in the fields below.
These sessions are delivered by Parent & Caregiver Support Services (PCSS), a provincially funded program offering universal, community-based parent education and support for parents and families with children ages 0 to 13.
WORKSHOP #1 (RAISING RESPONSIBLE TEENAGERS): Wednesday, February 9th from 6:30 - 8:00 PM
WORKSHOP #2 (RAISING CONFIDENT, COMPETENT TEENAGERS): Wednesday, February 16th from 6:30 - 8:00 PM
Learn more about us, our programs, and services by visiting our website: http://www.chestermere.ca/pcss
First Name*
Last Name*
Phone Number*
Email Address*
City or Town of Residence*
Postal Code*
Please select which workshop(s) you would like to attend from the options below:*
1. Workshop #1 - Raising Responsible Teenagers (February 9th)
2. Workshop #2 - Raising Confident, Competent Teenagers (February 16th)
Workshop Package(s)*
Each workshop includes a customized package with helpful resources and tip sheets to assist parents with the strategies and ideas that are discussed during our time together.
Please select the box below to acknowledge that you will be picking up your resource package(s)e at City Hall (105 Marina Drive).
1. I WILL PICK-UP MY RESOURCE PACKAGE(S) AT CITY HALL (we will send you an email with dates and times to pick-up)
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
Will someone else be joining you for this workshop?*
1. Yes
2. No
If yes, what is their relationship to you?
For example a spouse, parenting partner, friend, or another family member.
Are there any specific topics that you would like us to focus on during the workshop?
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.
Were you born in Canada?*
1. Yes
2. No
If you were born in Canada are you:
1. Indigenous
2. Francophone
3. None of the above
If you were NOT born in Canada, have you lived here for less than 3 years?
1. Yes
2. No
If you have lived in Canada for less than 3 years, where did you live before moving here?
Total Number of Children or Youth *
Please tell us how many children or youth that you care for.
Were your children or youth*
1. Born in Canada
2. Born outside of Canada
3. Born in Canada and outside of Canada
If born in Canada are your children or youth
1. Indigenous
2. Francophone
3. None of the above
If not born in Canada, have any been in Canada less than 3 years?
1. Yes
2. No
If applicable, how many have been in the country less than 3 years?
Date of Birth (1st Child)*
Date of Birth (1st Child)
Date of Birth (2nd Child)
Date of Birth (2nd Child)
Date of Birth (3rd Child)
Date of Birth (3rd Child)
Date of Birth (4th Child)
Date of Birth (4th Child)
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
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.
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.
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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Triple P TEEN Registration Form