T.E.A.C.H REGISTRATION FORM

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Parental consent is required to register if you are under the age of 18.

The Newmarket African Caribbean Canadian Association (NACCA) is delivering a six weeks mental health workshop series for Black youth ages 12-25 who reside in York Region. The program will be delivered in a hybrid (in-person and online) format. If you choose to participate in-person, transportation is not provided. Sessions will be held at NACCA's community centre at 449 Eagle Street, Newmarket. More information regarding the workshops will be sent once you have signed up. All sessions will be supported by a mental health clinician.

Completion of this form provides NACCA with the information needed to connect you to services that will best support your needs. All responses are bound by NACCA's confidentiality policy. Identifying information will only be shared with staff working with the program. Demographic information (ie. age, location) will be used for reporting purposes only.

Program Details

When: Wednesdays from Nov. 9, 2022 – Dec. 14, 2022
Where: In-person at 449 Eagle Street and virtual via zoom

Should you have any additional questions and/or concerns, please contact us:
Email: leronmhonsele@naccacommunity.ca
Phone: (905) 781-6222

First and Last Name (parent/guardian)

Informed Consent

I AGREE and consent to use my (or my child's if under 18) personal information (name, email, phone) to register for NACCA's T.E.A.C.H. program.

I Agree

Required

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