Registration Form

First Nations

Metis

Inuit

Non-status

SUPPORT PROGRAM

Indigenous Focusing Oriented Therapy

Indigenous Youth Addiction Program

Trauma Therapy Program

Services for Children with Special Needs Program

Family Strength Program

Employment for People with Disabilities Program

Respite Program

Addiction Relief Program

Chilliwack After School Program

Vancouver After School Program

CAMPS & ACTIVITIES

FACILITY

UGTS Daycare

Do you need transportation?

YES

NO

Is there a custody agreement in place?

YES

NO

Is your child up to date on their immunizations?

YES

NO

NOT IMMUNIZED

REGISTRATIONFORM

*required information

STATUS INFORMATION*

APPLICANTS INFORMATION*

WHAT ARE YOU REGISTERING FOR?*

If you are applying on behalf of a minor, please complete the following:

PARENT OR LEGAL GUARDIAN INFORMATION

CHILD'S INFORMATION

AUTHORIZED PERSONS FOR PICK UP

NOT AUTHORIZED PERSONS FOR PICK UP

If yes, upload here

APPLICANT OR CHILD'S EMERGENCY HEALTH INFORMATION

APPLICANT OR CHILD'S EMERGENCY CONTACT INFORMATION
Alternate person to call and pick up in case of an emergency

CHILD'S IMMUNIZATION INFORMATION

Type of Immunization

CHILD'S MEDICATION

CHILD'S ALLERGIES

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