Kids Have Stress Too! (Register)

Date Of Program (use this if multiple dates offered)

Desired Location:

In Person
Virtual

Adult Name: *

Adult Birthdate *

Adult Email: *

Address: *

City *

Province *

Postal Code *

Phone: *

Do You Live In The:

Would you like to receive email notification of our programs and events? *

Were you born in Canada?

If you were not born in Canada, how long have you lived in Canada?

If no, did you enter Canada as an immigrant or refugee? *

Are you an Indigenous person, that is, First Nations, Metis or Inuit?

Emergency Contact Name *

Emergency Contact Phone *

Where did you hear about us?

Child's Name (#1):

Child's Age (#1):

Child's Birthdate (#1):

Child's Gender (#1):

Female
Male

Your relationship to child (#1):

Was your child born in Canada? (#1)

If your child was not born in Canada, how long has your child lived in Canada? (#1)

If no, did you enter Canada as an immigrant or refugee? (#1)

Is your child an Indigenous person, that is, First Nations, Metis or Inuit? (#1)

Are there any special needs? (#1)

Child's Name (#2):

Child's Age (#2):

Child's Birthdate (#2):

Child's Gender (#2):

Female
Male

Your relationship to child (#2):

Was your child born in Canada? (#2)

If your child was not born in Canada, how long has your child lived in Canada? (#2)

If no, did you enter Canada as an immigrant or refugee? (#2)

Is your child an Indigenous person, that is, First Nations, Metis or Inuit? (#2)

Are there any special needs? (#2)

Child's Name (#3):

Child's Age (#3):

Child's Birthdate (#3):

Child's Gender (#3):

Female
Male

Your relationship to child (#3):

Was your child born in Canada? (#3)

If your child was not born in Canada, how long has your child lived in Canada? (#3)

If no, did you enter Canada as an immigrant or refugee? (#3)

Is your child an Indigenous person, that is, First Nations, Metis or Inuit? (#3)

Are there any special needs? (#3)

Additional Comments:

If you have anything more to add, please request a callback.

What is two times two? *

Kids Have Stress Too! (Register)

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