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Vermilion River Community Learning

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Registration Form

"*" indicates required fields

Name*

First Last

Parent's Name

First Last

if registering for a child

Primary Phone*

Secondary Phone

Email*

Address*

Street Address Address Line 2 City Province Postal Code

Courses

Please select the course(s) you'd like to register for. Payments can be made by cheque, cash, or e-transfer to payments@classab.ca after you complete this form.

Class*

Coffee Time Tech Tips

English Language Class (Vermilion)

Canvas Word Fun

With Brave Wings

Pencil Portraits Worshop

Rhyme and Read

Additional Class

Just one class for me.

Coffee Time Tech Tips

English Language Class (Vermilion)

Canvas Word Fun

Pencil Portraits Workshop

With Brave Wings

Rhyme and Read

Total

How did you hear about this program?

Flyer

Poster

Social Media

Other

select all that apply

Please share how you heard about this program.

For Our Funder

The following information is collected for the purpose of reporting to our funder, no names are used when reporting. Please fill out as much of this section as you are comfortable with.

Gender

Male

Female

Other

Prefer not to disclose

Year of Birth

Status

Canadian Citizen

First Nations/ Metis / Inuit

Permanent or Temporary Resident / Refugee

Unknown

Schooling

No schooling

Grades 1-6

Grades 7-9

Grades 10-12

Some Post-secondary

Post-secondary Graduate

Special Education

Unknown

Will you travel more than 50km one way for this program?

Yes

No

Do you have problems in any of the following areas?

Financial (money)

Childcare

Transportation

Belonging

Confidence

Learning

Family Issues

Parenting

Racism

English Language

Housing Needs

Food

Marketing & Consent

Please send me email notices for

Fall & Winter Flyer (sent out twice per year)

Art Classes

General, Personal Development classes

Technology/ Business classes

Newcomer information

CLASS Events

Consent*

I authorize CLASS to use names, photos and testimonials of myself and/or my child for awareness and promotion purposes. (social media, displays and newspaper).

Consent*

I authorize CLASS to contact me about the classes I am registered in.

Signature

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