Young Adults and Adult Registration Form To access VOHRC programs and services every client must complete a registration form. Collected information is protected by the Privacy Legislation and is used only to meet reporting requirements for funding.General InformationFirst Name *Last NamePhone *Email Address *About YourselfGender *MaleFemaleOtherAge18-2425- 6465+Marital Status *SingleMarriedCommon LawSeparatedDivorcedWidowedWere you born outside of Canada? *YesNoIf your first language is not English what would it be?Cultural Identity, (Select All that Apply) *BlackSouth AsianCaucasianAsianHispanicOtherPlease choose which programs you'd like to register for: *Seniors Drop-inFood Supplement ProgramComputer trainingCulinary Art programParenting SupportYouth for Change 12- 15Youth for Change Drop-in 16- 24Youth Advisory Committee 24-29Black Queens Girls ClubCommunity Development ActivitiesVolunteerConsent *Yes, I agree with the privacy policy and terms and conditions.Photo Consent *Yes - I hereby consent to taking and use of photographs of me for promotional purposesNo - I don’t consent to taking and use of photographs of me for promotional purposesSubmit Registration
