Family Program Registration

* What program would you register for?

* First Name:

* Last Name:

* Date of Birth:

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* Status Number:

* Band or Nation:

* Email Address:

* Address:

* Postal Code:

* Phone Number:

Will you attend with someone? Please select and enter their information below.

First Name:

Last Name:

Date of Birth:

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Status Number:

Children Information:

Child's First & Last Name:

Date of Birth:

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Gender:

Status Number:

Child's First & Last Name:

Date of Birth:

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Gender:

Status Number:

Child's First & Last Name:

Date of Birth:

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Gender:

Status Number:

Special Considerations:

Do you or your child have any specific needs that our staff need to know about?

Does you or your child have any dietary restrictions our staff need to know about?

Other limitations:

Consent to Take and Use Photographs: Photographs may be taken of you/your child(ren) during program hours. Westbank First Nation would like to use these photos in reports or presentations for the purpose of fundraising and promotion of this and other parenting education programs. Do you consent to this?

Family Circle Participation Agreement:

* In consideration of our families participating in Family Program(s), I agree to abide by the following requirements and responsibilities: 1. I will provide notification if I am not able to attend a program; for catering, space and childcare needs. 2. I will follow program guidelines (participant created). 3. I will meet the minimum attendance requirement; 6 out of 8 sessions or a quarter of the agenda. Further I acknowledge that my failure to abide by the participation requirements and policies may result in the loss of special privileges or special session gifts and events. I agree to abide by the Family Program requirements and to follow instructions:

Waiver of Liability and Assumption of Risk:

* I acknowledge and agree that I am the parent or legal guardian or other of the listed children in the registration form in which I and my children attend WFN Family Program(s). I further agree to release and forever discharge Westbank First Nation, its affiliated corporations, officers, employees, servants, agents, heirs, successors and assigns from all liability for any and all loss or damage and any claim or demands therefore on account of injury to myself / child or mine/child’s property and whether cause by the negligence of the WFN or otherwise. I assume full responsibility and risk of bodily injury, death or property damage associated with the program, whether due to negligence of the WFN or otherwise. I hereby agree to indemnify and hold harmless the WFN from any and all claims, actions, liabilities, complaints, damages and otherwise arising from myself or child’s participation in the program, including any remedies which may subsist in law equity or under legislation.