Family Matters Registration Form 2022-2023

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Please fill out this form to register for the Family Matters Program, taking place Fridays at Marcel Giroux from 12:30 - 2:30PM. Participants should expect a one week delay before participating after registration. New registration to open July 2023 for fall dates. To see other CCS Programs please visit https://www.ccs-montreal.org/childandfamily

Email *

Which session are you registering for? Select all that apply. *

Fall Session (October 7 - November 25, 2022)

Spring Session (April 28 -June 16, 2023)

Required

Child's First and Last Name *

Child's Date of Birth *

YYYY

Do you have more than one child that will participate in the program? If so, please list the names and ages of the other children participating. *

Child's Current Address: Street Name & Number (including Apartment Number if applicable), City, Province, & Postal Code *

Participating Parent's First and Last Name *

Parent/Guardian 2 First and Last Name (if applicable)

Participating Parent's Telephone Number *

Does your child have any allergies or health concerns we should be aware of? *

Is there anything else you would like us to know about your or your child?

Emergency Contact First and Last Name *

Emergency Contact Relationship to Child *

Emergency Contact Phone Number *

Collective Community Services Photo Authorization *

Yes, I authorize CCS to use any photos of myself and/or my children for use in publicity tools INCLUDING their face

Yes, I authorize CCS to use any photos of myself and/or my children for use in publicity tools EXCLUDING their face

No, I do not authorize CCS to use any photos of myself or my children in publicity tools

Required

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