LINKS Distance Fall Program 2021 Registration
Note: this form is registration for one on one, 45 minute sessions, online instruction only.
Please fill out the following form to register your student for the Fall term. The email provided to us in the section below will receive a Response Receipt for this registration form. If you are not the student's Primary Caregiver, please make sure they receive a copy of the Response Receipt.
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Email *
COST for LINKS Distance
$450

Please Note: All NEW STUDENTS must be assessed before they are able to attend programming. There is a $50 assessment fee; however, assessments are only needed if a student has not previously attended the LINKS program OR if the student has been out of the LINKS program for a year.
Student Information
Full Name of Student *
Student Pronouns
Date of Birth *
MM
/
DD
/
YYYY
Grade *
Current School *
Please check what applies to the enrolled student *
Program, Date & Time Slots
PLEASE INDICATE WHICH DAY/TIMESLOT YOU WOULD LIKE TO BE ENROLLED IN

The LINKS Fall program runs 2 days a week, either Mondays/Wednesdays or Tuesdays/Thursdays

The START date is October 4th for M/W, ending December 6th | October 5th for T/TH and ends December 9th for a total of 18 sessions.
Please pick at least TWO possible timeslots for your student.
Note: Every attempt to accommodate requests will be made but due to limited enrollment, timeslots will be assigned on a first come first serve basis. If your chosen timeslot becomes unavailable and you would still like to register, you will be given the option to choose another timeslot or to be put on a waitlist.
PAYMENT INFORMATION
Is your student new to the LINKS program?
Clear selection
If Yes, please note that all new students must undergo an assessment before beginning the program. There is a $50 dollar assessment fee that is added on top of the $450 for one-on-one Distance Instruction.
This $50 Assessment fee is a one time cost, and does not repeat should your student be enrolled for subsequent terms.
How Will you be paying?
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PLEASE NOTE
If your student was funded previously through your student's school you MUST contact them regarding re-enrollment.
If you are planning to pay by Visa or Master Card, please list your card number and expiration date in the space provided. Please DO NOT include your cvv.
Regarding E-transfers
If you intend to pay via E-transfer, please transfer funds to info@chisholm4children.ca. A password MUST be indicated in a separate email
Regarding other Payment Methods
If you are intending to pay via one of the other methods indicated, you MUST contact the office at either info@chisholm4children.ca or 902-377-3280 to arrange payment. If you are uncomfortable listing your credit card information in this form, then you may also contact the office to provide it in that manner.
Caregiver information
The following information will allow us to contact you (or other provided persons) in order to set up assessments, provide end of term reports or invoices/receipts, and direct us as to where we should deliver program materials.
Primary Caregiver(s) *
Caregiver Pronouns
Mailing Address *
Email(s) *
Phone Number *
Who is Submitting this Registration *
If you are not the student's Caregiver and are submitting this registration, please fill in your name, email and phone number.
SELF-IDENTIFICATION - Completion of this section is voluntary
Caregivers and/or students are encouraged to self-identify. By doing so the LINKS program can have a greater awareness of the diversity of the student population and the communities served and to better meet the educational needs of students.
INDIGENOUS - For the purpose of this form, Indigenous persons are those who consider themselves to be Mi’kmaw/other First Nations, Métis, or Inuit.
Clear selection
If YES, to which group(s) do you belong?
If you chose "Other First Nation not listed" to the Above section and would like to specify, please do so here:
ANCESTRY - Please indicate the ancestry with which the student most identifies. Select all that apply.
Additional Notes or Comments:
A copy of your responses will be emailed to the address you provided.
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