Wellness Center Registration Form 2025-2026
Fort McKay Wellness Center Participant Registration Form for September 2025-June 2026
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Name of Person filling out this form *
Child's First and Last Name *
Child's Alberta Health Care Number *
Child's Birth Date *
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Child's Address *
School Child Attends *
Parent/Guardian Name (1) *
Parent/Guardian Phone Number *
Parent/Guardian Email
2nd Parent/Guardian Name
2nd Parent/Guardian Phone Number
2nd Parent/Guardian Email
Emergency Contact 1 (Name and Phone Number) *
Emergency Contact 2 (Name and Phone Number) *
Health Information (Allergies, heath conditions, diagnosis, dietary sensitivities) *
Waiver: I acknowledge that there are risks associated with entering the Fort McKay Wellness Center and/or participating in any of its programs or activities, and that the measures taken by the Fort McKay Women’s Association and participants (including those set out in the After School Program Relaunch Plan) will not entirely eliminate those risks. I will not hold the Fort McKay Women’s Association liable. 
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Photo/Video Consent

I give permission for the Fort McKay Wellness Center to photograph my child for the purpose of:
▪    publication in the Red River Current
▪    highlighting program initiatives in reports to our funders
▪    posting activities/photos on our secure, private Facebook and Instagram pages
▪    Sharing photos with the Fort McKay First Nation to utilize in their community reports, quarterly general meetings or on their Social Media Pages.
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Date form Completed
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