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Brighter Futures Coalition of St. John's and District
Family Registration Form
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Email *
Parent's/Guardians name (s) *
Address *
Phone Number (s) *
Emergency Name and Phone Number *
Number of persons in your immediate family *
Children's names and dates of birth - Please list any allergies, dietary restrictions, special needs or illnesses *
Family Income ( this is used for statistical information for our funders *
Required
What is your status in Canada? *
What languages are spoken in your home? *
Do you have Aboriginal Status? *
Required
Every effort will be made to provide a safe play environment. In case of an accident or injury to myself or the children named above, I waive any claim that I may have against Brighter Futures Coalition and District arising from the participation in any aspect of the program. When you participate in any Brighter Futures Programs, you do so at your own risk. (Refusal to sign will result in you and your child (ren) not being able to attend Brighter Futures Programs. *
I give Brighter Futures Coalition consent to Photograph and or videotape me and my child and to use the photos and video footage for purpose of Program evaluation, webiste photo gallery, and or promotional material. Prior to taking pictures, parents are required to obtain permission from parents of children who appear in any pictures taken during the playgroup session. *
We have a long standing practice of protecting the privacy of participants in our program. We want to assure you that any information you provide to us will be kept in the strictest confidence. In return, we ask that you respect our policies around privacy. In the course of attending programs, you may become aware of personal and confidential information. Brighter Futures depends on the maturity and loyality of each participant to keep private such information. Confidential information pertaining to programs, fellow participants, including use of pictures attained at programs, must not be used without prior consent. *
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