CHANGE Health Community Program Registration
CHANGE Health Community Program supports Alberta families to learn, or re-learn healthy living through lifelong healthy nutrition, active lifestyles, mental well-being and positive social connections.
Parents and children will learn alongside of health professionals about nutrition, physical activity, mental wellbeing and social connections in their community. We are inviting families in your community to participate in this research-based program.
Each participant has to fill out this form to register, including children
Last Name *
First Name *
Birthdate *
MM
/
DD
/
YYYY
Gender *
Ethnicity
Apt #
Street # *
City *
Province *
Postal Code *
Email Address
Phone Number
Do you have a family doctor? *
Family Doctor Name:
Any dietary Restrictions? (Allergies or Intolerances, Vegetarian, Halal)
Any health or behavior concerns to be aware of?
Family members participating(full name, age, gender, ethnicity) *
Local Site for program *
Required
Submit
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