Registration is now open! Please complete all of the sections of the form. CYPRES Registration 2023-2024 Step 1 of 3 33% Participant's InformationParticipant's Name First Last Participant's Gender* Male Female Participant's Date of Birth* Year Month Day Participant's Home Address* Street Address Address Line 2 City AlbertaBritish ColumbiaManitobaNew BrunswickNewfoundland and LabradorNorthwest TerritoriesNova ScotiaNunavutOntarioPrince Edward IslandQuebecSaskatchewanYukon Province Postal Code Program InformationWhat school does your child attend (click to select)?*Caledonia Centennial Public SchoolJL Mitchener Public SchoolRiver Heights Public SchoolSt. Patricks Catholic SchoolSt. Stephen's Catholic SchoolSelect the school your child is attending in September from the drop down menu.What grade is your child going into in September? (click to select)?*JK/SKGrade 1-6Select the grade your child is going into in September from the drop down menu.Days of the week child will be attending the ProgramWe are only able to accommodate a full time schedule. This includes all 5 days before school OR all 5 days after school OR all 5 days before and after school.Mondays 7:00am - 9:00am 3:00pm - 6:00pm Tuesdays 7:00am - 9:00am 3:00pm - 6:00pm Wednesdays 7:00am - 9:00am 3:00pm - 6:00pm Thursdays 7:00am - 9:00am 3:00pm - 6:00pm Fridays 7:00am - 9:00am 3:00pm - 6:00pm Parent/Guardian #1 InformationFull Name* First Last Email Address* Home Address* Same as Participant Street Address Address Line 2 City AlbertaBritish ColumbiaManitobaNew BrunswickNewfoundland and LabradorNorthwest TerritoriesNova ScotiaNunavutOntarioPrince Edward IslandQuebecSaskatchewanYukon Province Postal Code Home Phone*Mobile Phone*Place of Employment* Work Address* Street Address Address Line 2 City AlbertaBritish ColumbiaManitobaNew BrunswickNewfoundland and LabradorNorthwest TerritoriesNova ScotiaNunavutOntarioPrince Edward IslandQuebecSaskatchewanYukon Province Postal Code Work Phone*Parent/Guardian #2 InformationIf this is not applicable then please re-enter Parent/Guardian #1 InformationFull Name* First Last Email Address* Home Address* Same as Participant Street Address Address Line 2 City AlbertaBritish ColumbiaManitobaNew BrunswickNewfoundland and LabradorNorthwest TerritoriesNova ScotiaNunavutOntarioPrince Edward IslandQuebecSaskatchewanYukon Province Postal Code Home Phone*Mobile Phone*Place of Employment* Work Address* Street Address Address Line 2 City AlbertaBritish ColumbiaManitobaNew BrunswickNewfoundland and LabradorNorthwest TerritoriesNova ScotiaNunavutOntarioPrince Edward IslandQuebecSaskatchewanYukon Province Postal Code Work Phone*Custody AgreementsAre there custody agreements pertaining to legal right of access to your child?* Yes No Please provide more information on your custody agreement.*You will be required to provide appropriate legal documents (eg. Court Order) for our records. Emergency Contact InformationWe will always contact parents first. Please choose someone other than the primary parents/guardians as an emergency contact.Emergency Contact Name* First Last Relationship to the Participant* Primary Phone #*Secondary Phone #*Person(s) to whom the Participant MAY BE released (Other than previously listed)* Is there anyone who is NOT ALLOWED to pick up your child?* Yes No Person(s) to whom the Participant MAY NOT be released* Medical InformationFamily Doctor's Name* Family Doctor's Phone #*Are the participant's immunizations up to date?* Yes No Does the participant have any allergies?* Yes No Please list allergies Are any of the allergies life threatening?* Yes No If the participant has life threatening allergies the parent/guardian will need to fill out an emergency response form.Please list life threatening allergies* Does the participant have any health problems or limitations that would affect their ability to participate in the program? (eg. Hearing, speech, physical or emotional delays)* Yes No Please provide more information on health problems/limitations.*Additional information you would like to share with our staff.*I consent to receiving important updates and reminders VIA email from the CYPRES Children & Youth Program.* Yes No