2023 Youth Registration
In order to participate in the North Hastings Children's Services youth programs such as the Youth Advisory Board and YOURSPACE we require you to register using the following form.
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First name *
Please complete if you go by another first name?
Last Name *
Date of Birth *
MM
/
DD
/
YYYY
Mailing Address (street/road, town/city) *
Phone Number *
Can we call and text you? *
Municipality/Township you live in (example Maynooth is in Hastings Highlands) *
What is your gender? (select all that apply)
Acknowledgement - My parent/guardian has given me permission to complete this registration *
Parent/Guardian Name #1 (put N/A if you live alone) *
Parent/Guardian Phone Number
Parent/Guardian Name #2 (optional)
Optional Registration Information - In order to deliver quality and relevant programming please complete any or all of this voluntary section.  Your information will be kept confidential.  Myself and/or my family is connected to the following group (please check all that apply)
Indigenous Identity *
Why are you registering with us? (check all that apply) *
Required
I currently am getting support from: (list any social workers, doctors or services you would like to share)
I want to have programs that include:  (check all that may apply to you and/or your friends needs)
Policies - 1.  I agree that I am responsible for my own actions and behaviours while attending the programs, 2. I release North Hastings Children's Services from all responsibility in respect of any injuries which result from using materials, 3. I understand that should I have a concern regarding the quality, access or equity in any of the youth programs I can email the Executive Director at janderson@nhcs.ca or call 613-332-0179 at any time. *
Photo Consent and Release - I grant permission to North Hastings Children's Services (NHCS) to publish for internal and external purposes, articles and stories, photos, video and audio footage of myself.  I understand that NHCS will use this material in publications, in marketing, communications and advertising material and on its internal properties, both now and in the future.  The materials will remain the exclusive property of NHCS, and may be reproduced by NHCS, and anyone it has authorized, without compensation or payment to the individuals concerned or any other person. *
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