Falconridge Registration
Starting September 18, the program will run every Thursday from 3:00 PM to 5:00 PM. For any questions, please contact Grace at GTanku@cbfy.ca
STUDENT INFORMATION:
Student Name
*
First Name
Middle Name
Last Name
Birthdate
*
-
Month
-
Day
Year
Date
Gender [Ex. Male or Female]
*
Current School Name
*
Current Grade
*
Please Select
Grade 1
Grade 2
Grade 3
Grade 4
Grade 5
Grade 6
Country of Birth
*
Ethnicity
*
Immigration Status
*
Please Select
Canadian Citizen
Permanent Resident
Study Permit
Refugee Claimant
Visitor Record
Other
Alberta Health Card Number
*
Allergies/Food Restrictions/Medications
*
Home Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
PARENT/GUARDIAN INFORMATION:
Parent/Guardian #1
*
First Name
Last Name
Relationship to child [Ex. Mother, Father, etc.]
*
Parent/Guardian 1 Phone Number
*
Please enter a valid phone number.
Parent/Guardian #1 Email Address
*
Parent/Guardian #2
First Name
Last Name
Relationship to child [Ex. Mother, Father, etc.]
Parent/Guardian #2 Phone Number
Please enter a valid phone number.
Parent/Guardian #2 Email Address
Emergency Contact Name [Should be different than above parent(s)/guardian(s)
*
First Name
Last Name
Relationship to child [Ex. Mother, Father, etc.]
*
Emergency Contact Phone Number
*
Please enter a valid phone number.
PICK-UP INFORMATION:
How will your child get home?
*
Please Select
Walk home [Must be 9 years or older]
Pick-up
Who will pick up your child? [Ex. Mother, Aunt, Grandfather, etc.]
*
Name of Pick-Up Person
*
First Name
Last Name
Phone Number of Pick-Up Person
*
Please enter a valid phone number.
Have you attended a CBFY program before?
*
Please Select
Yes
No
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Consent to Share Information with Your Child’s School & other Stakeholders.
The CBFY offers support to families, and their school-aged hildren enrolled in the schools. In order to participate in any of the programs, CBFY requests’ participants to provide important information. The CBFY will also refer your child (ren) to other agencies, as needed, and personal information will be shared with them. To protect students and their families' privacy, CBFY requires parental consent to comply with the Freedom of Information and Protection of Privacy Act (FOIP). This authorization will allow CBFY to access to the necessary information to provide settlement support and services, and to share it with other agencies as needed.
Consent to Share Information with Your Child’s School & other Stakeholders:
*
Yes
No
Consent to ReleaseInformation and Possible Future Research to Immigration Refugee CitizenshipCanada
The CBFY Programs are funded by Immigration, Refugees and Citizenship Canada (IRCC). To support your ongoing settlement needs, IRCC would like to request your permission to contact you in the future. CBFY will protect any information collected from you under the authority of Alberta's Freedom of Information and Protection of Privacy Act(FOIP).I hereby give consent for IRCC to obtain information to support research and funding programs that serve newcomer families and youth in Canada.
Consent to Release Information and Possible Future Research to Immigration Refugee Citizenship Canada:
*
Yes
No
Consent to Participate in Program ResearchActivities
Participating in the SWIS/ESWIS Program means CBFY may invite your child to participate in surveys and focus groups. The purpose of this research is to evaluate our program and ensure CBFY continues to offer exceptional services to newcomer youth. All surveys and focus groups are confidential. This means that CBFY will never share your child's name and/or identity with anyone outside of CBFY. I have read and understood the information provided.
Consent to Participate in Program Research Activities
*
Yes
No
Emergency Consent Acknowledgement
In case of anemergency or illness, CBFY will make every effort to contact theparents/guardians. In the event that CBFY cannot make contact in a timelymanner, I agree that a qualified medical professional may attend to my child(ren).
Emergency Consent Acknowledgement:
*
I agree
I do not agree
Consent for Media Release
CBFY may film, photograph, produce electronic images, and provide theopportunity for my child (ren) to participate in social media coverage (e.g.,Facebook, Instagram, and Twitter) of our programs or media interviews.
Consent for Media Release:
*
I agree
I do not agree
Liability Waiver
I accept that as the child’s legal parent/guardian I give permission for my child(ren) to participate in the Bridge Club activities and release CBFY of all responsibility and liability with respect to any and all of the activities.
Liability Waiver
*
Yes
No
Please type your name as if you are signing the waiver document above.
*
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