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Bundle of Support - Registration Form

  1. REGISTRATION FORM

    INSTRUCTIONS: Please provide your information in the fields below to register for our support group (Bundle of Supports). This should be completed by the individual who is planning to attend the group. Please ensure that you include a response for all fields with an asterisk (*).

    DATES: 6-week program starting on Tuesday, November 1st - Tuesday, December 13th, 2022 from 10:00 - 11:30am.

    LOCATION: TBD

  2. CONTACT INFORMATION
  3. Please provide the best phone number that you can be reached at
  4. We will be sending an email with the instructions to join the virtual support group as well as different resources throughout our time together.
  5. SAFETY INFORMATION
  6. Do you have any allergies, dietary or medical conditions (including behavioral needs) that may might need to respond to during program?*
  7. Do you have any legal no-contact orders (ie. restraining orders) or other restrictions on contact we should be aware of?*
  8. Are there any current safety concerns we should be aware of?*
  9. FAMILY DEMOGRAPHICS
    WHY DO WE ASK FOR THIS INFORMATION? The demographic information collected in this section is used for reporting purposes only as required by our funder. Any question with an asterisk (*) is mandatory to complete, but those without can be skipped.
  10. Were you born in Canada?*
  11. Do you self-identify as:*
  12. If you were NOT born in Canada, have you lived here for :
  13. Gender Identity
  14. Ethnic Identities
  15. Immigration Status
  16. Were your children:*
  17. E.g. Facebook, Synergy, FCSS, Trellis, Healthy Families, PCSS Facebook, City of Chestermere website, etc.

  18. Thank you for taking the time to complete this form. We look forward to connecting with you!
  19. 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.

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  21. Leave This Blank:

  22. This field is not part of the form submission.