Youth Program Registration Form To access Vision of Hope Resource Centre Services every client must complete a registration form. Collected information is protected by the Privacy Legislation and is used to meet reporting requirements.Child InformationTo register your child for program, we will need the following information:Child First Name *Child Last Name *Choose ProgramAfter School ProgramBlack QueensSummer CampYouth Advisory CouncilYouth for ChangeYouth Drop-In ProgramYouth EventDate of Birth *MonthSelect month123456789101112DaySelect day12345678910111213141516171819202122232425262728293031YearSelect Year212521242123212221212120211921182117211621152114211321122111211021092108210721062105210421032102210121002099209820972096209520942093209220912090208920882087208620852084208320822081208020792078207720762075207420732072207120702069206820672066206520642063206220612060205920582057205620552054205320522051205020492048204720462045204420432042204120402039203820372036203520342033203220312030202920282027202620252024202320222021202020192018201720162015201420132012201120102009200820072006200520042003200220012000199919981997199619951994199319921991199019891988198719861985198419831982198119801979197819771976197519741973197219711970196919681967196619651964196319621961196019591958195719561955195419531952195119501949194819471946194519441943194219411940193919381937193619351934193319321931193019291928192719261925Choose Gender *MaleFemaleOtherResidence/Address *City *Province *Postal Code *Parent InformationTo register your child for program, we will need the following contact information:Parent/Guardian 1 - Full Name *Email AddressPhoneParent/Guardian 2 - Full Name *Email AddressPhoneEmergency InformationVision of Hope Resource Centre staff will do everything possible to ensure that all youth are safe and sound. However, unintended emergencies do arise in life, and in these undesirable situations we need to have the information need to help you, and your child, to the best of our abilities.Emergency Contact Full Name: *Emergency Contact Email Address:Emergency Contact Phone Number: *Physician/Doctor Full Name:Physician/Doctor Phone Number:Please inform us of any Allergies, Health Problems or Illness, as well as any medication they are taking:Child's Health Card NumberTerms & AgreementVision of Hope Resource Centre will do everything we can to keep your child safe, engage, growing and happy. However, we need your permission to do so. So, your child to participate in this cohort of Youth For Change, we will need you to agree to the following statements below. Check the corresponding box to agree to the following statements:Consent * As parent or guardian of the child named above, I grant permission for my child's participation in all the Youth For Change educational and social activities listed above - including trips by school bus. As parent and guardian, I understand that I am responsible for my child after then leave program, and am responsible for their transportation home I have read the organization description, program description, and list of potential sessions. I approve of my child’s participation, and I accept the risks associated with my child’s participation. In the event of an emergency while my child is attending the Youth For Change program, where VOHRC staff is unable to contact me for my consent for medical care, I consent in advance to such emergency care, including hospital care, as may be deemed necessary under the circumstances. r I acknowledge that my child may be photographed and/or videotaped for use Vision of Hope Resource Centre promotional and educational materials. However, they will not be identified by name in the materials. I provide my consent to VOHRC, and all those acting with VOHRC’s approval, my to use these photos and video for such purposes I understand that my child has a role to play in regard to their safety and security. I will speak with my child about the need to honor rules and to behave responsibly. Submit Registration
