Name* First Last Parent's Name First Last if registering for a childPrimary Phone*Secondary PhoneEmail* Address* Street Address Address Line 2 City AlbertaBritish ColumbiaManitobaNew BrunswickNewfoundland and LabradorNorthwest TerritoriesNova ScotiaNunavutOntarioPrince Edward IslandQuebecSaskatchewanYukon Province Postal Code CoursesPlease 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.Course Name*Please choose from the list.English Language ClassCourse NameNo, just one course for me.Total $ 0.00 CAD How did you hear about this program? Flyer Poster Social Media Other select all that applyPlease share how you heard about this program. For Our FunderThe 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 & ConsentPlease 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
