Early Childhood Development: Kikosewin Family Resource Network

Tuesdays

Jan. 14th - March 18th

2:00PM – 3:30PM

Location: Bent Arrow

Music Movement and Game:

Being with Family ECD Program (Music, Movement & Game)

You are registering for: Music, Movement and Game

Primary Caregiver Contact Information:

First Name

Last Name

Date of Birth (M/D/Y)

Email

Phone

Preferred Method of Contact

Best Time to Contact You

Address

Address Line 1

Address Line 2

City

Province

Postal Code

Country

Send me the latest information, services, programs, or events

Secondary Caregiver Contact Information (If Attending):

First Name

Last Name

General Information

Do you identify as Indigenous?

What is your band, tribe or settlement?

Ethnicity

Gender

Other (Please Specify)

Are you new to our programs, or a returning participant?

Do you have a connection with any other Kikosewin/Bent Arrow services?

What program/service?

Have you been involved in Child and Family Service (CFS) before?

Do you live with any dietary restrictions?

What dietary restrictions or allergies do you live with?

How did you find us? Referred by:

Other (Please Specify)

Youth (Ages 0-5):

How many youth (ages 0-5) will be accompanying you?

Youth #1 :

First Name

Last Name

Date of Birth (M/D/Y)

Relationship to Participant

Youth #2:

First Name

Last Name

Date of Birth (M/D/Y)

Relationship to Participant

Youth #3:

First Name

Last Name

Date of Birth (M/D/Y)

Relationship to Participant

Consent

I give consent to Kikosewin Family Resource Network for collecting my information. I understand that all personal information in this form is protected by the Freedom of Information and Protection of Privacy Act of Alberta. I authorize Kikosewin FRN to share this information within programs when needed to provide the best support services possible.

Yes, I give consent

I agree to accept and access services through Kikosewin Family Resource Network. I understand that these services are voluntary, and that I have the right to withdraw from services without reason or consequences. I also recognize that my attendance in meetings and active participation are important for optimizing the supports that I access.

Yes, I give consent

Storytelling:

Being with Family ECD Program (Storytelling)

You are registering for: Storytelling

Primary Caregiver Contact Information:

First Name

Last Name

Date of Birth (M/D/Y)

Email

Phone

Preferred Method of Contact

Best Time to Contact You

Address

Address Line 1

Address Line 2

City

Province

Postal Code

Country

Send me the latest information, services, programs, or events

Secondary Caregiver Contact Information (If Attending):

First Name

Last Name

General Information

Do you identify as Indigenous?

What is your band, tribe or settlement?

Ethnicity

Gender

Other (Please Specify)

Are you new to our programs, or a returning participant?

Do you have a connection with any other Kikosewin/Bent Arrow services?

What program/service?

Have you been involved in Child and Family Service (CFS) before?

Do you live with any dietary restrictions?

What dietary restrictions or allergies do you live with?

How did you find us? Referred by:

Other (Please Specify)

Youth (Ages 0-5):

How many youth (ages 0-5) will be accompanying you?

Youth #1 :

First Name

Last Name

Date of Birth (M/D/Y)

Relationship to Participant

Youth #2:

First Name

Last Name

Date of Birth (M/D/Y)

Relationship to Participant

Youth #3:

First Name

Last Name

Date of Birth (M/D/Y)

Relationship to Participant

Consent

I give consent to Kikosewin Family Resource Network for collecting my information. I understand that all personal information in this form is protected by the Freedom of Information and Protection of Privacy Act of Alberta. I authorize Kikosewin FRN to share this information within programs when needed to provide the best support services possible.

Yes, I give consent

I agree to accept and access services through Kikosewin Family Resource Network. I understand that these services are voluntary, and that I have the right to withdraw from services without reason or consequences. I also recognize that my attendance in meetings and active participation are important for optimizing the supports that I access.

Yes, I give consent

People in Our Neighborhood:

Being with Family ECD Program (People in Our Neighborhood)

You are registering for: People in Our Neighborhood

Primary Caregiver Contact Information:

First Name

Last Name

Date of Birth (M/D/Y)

Email

Phone

Preferred Method of Contact

Best Time to Contact You

Address

Address Line 1

Address Line 2

City

Province

Postal Code

Country

Send me the latest information, services, programs, or events

Secondary Caregiver Contact Information (If Attending):

First Name

Last Name

General Information

Do you identify as Indigenous?

What is your band, tribe or settlement?

Ethnicity

Gender

Other (Please Specify)

Are you new to our programs, or a returning participant?

Do you have a connection with any other Kikosewin/Bent Arrow services?

What program/service?

Have you been involved in Child and Family Service (CFS) before?

Do you live with any dietary restrictions?

What dietary restrictions or allergies do you live with?

How did you find us? Referred by:

Other (Please Specify)

Youth (Ages 0-5):

How many youth (ages 0-5) will be accompanying you?

Youth #1 :

First Name

Last Name

Date of Birth (M/D/Y)

Relationship to Participant

Youth #2:

First Name

Last Name

Date of Birth (M/D/Y)

Relationship to Participant

Youth #3:

First Name

Last Name

Date of Birth (M/D/Y)

Relationship to Participant

Consent

I give consent to Kikosewin Family Resource Network for collecting my information. I understand that all personal information in this form is protected by the Freedom of Information and Protection of Privacy Act of Alberta. I authorize Kikosewin FRN to share this information within programs when needed to provide the best support services possible.

Yes, I give consent

I agree to accept and access services through Kikosewin Family Resource Network. I understand that these services are voluntary, and that I have the right to withdraw from services without reason or consequences. I also recognize that my attendance in meetings and active participation are important for optimizing the supports that I access.

Yes, I give consent

Connecting with Our Land:

Being with Family ECD Program (Connecting with Our Land)

You are registering for: Connecting with Our Land

Primary Caregiver Contact Information:

First Name

Last Name

Date of Birth (M/D/Y)

Email

Phone

Preferred Method of Contact

Best Time to Contact You

Address

Address Line 1

Address Line 2

City

Province

Postal Code

Country

Send me the latest information, services, programs, or events

Secondary Caregiver Contact Information (If Attending):

First Name

Last Name

General Information

Do you identify as Indigenous?

What is your band, tribe or settlement?

Ethnicity

Gender

Other (Please Specify)

Are you new to our programs, or a returning participant?

Do you have a connection with any other Kikosewin/Bent Arrow services?

What program/service?

Have you been involved in Child and Family Service (CFS) before?

Do you live with any dietary restrictions?

What dietary restrictions or allergies do you live with?

How did you find us? Referred by:

Other (Please Specify)

Youth (Ages 0-5):

How many youth (ages 0-5) will be accompanying you?

Youth #1 :

First Name

Last Name

Date of Birth (M/D/Y)

Relationship to Participant

Youth #2:

First Name

Last Name

Date of Birth (M/D/Y)

Relationship to Participant

Youth #3:

First Name

Last Name

Date of Birth (M/D/Y)

Relationship to Participant

Consent

I give consent to Kikosewin Family Resource Network for collecting my information. I understand that all personal information in this form is protected by the Freedom of Information and Protection of Privacy Act of Alberta. I authorize Kikosewin FRN to share this information within programs when needed to provide the best support services possible.

Yes, I give consent

I agree to accept and access services through Kikosewin Family Resource Network. I understand that these services are voluntary, and that I have the right to withdraw from services without reason or consequences. I also recognize that my attendance in meetings and active participation are important for optimizing the supports that I access.

Yes, I give consent

Early Childhood Development

Early Childhood Development: Programs & Events

All programs & events are free

Wednesdays

9:00AM – 12:00PM

Health for Two Educational Program

Tuesdays

Jan. 14th - March 18th

2:00PM – 3:30PM

Music Movement and Game:

Storytelling:

People in Our Neighborhood:

Connecting with Our Land:

Being with Family ECD Program

Music Movement and Game

Storytelling

People in Our Neighborhood

Connecting with Our Land

Questions? Reach us at 780-481-3451 or kikosewin@bentarrow.ca

Contact Kikosewin Family Resource Network

CONTACT

PROGRAMS

GET INVOLVED

STAY UP-TO-DATE

Early Childhood Development

Early Childhood Development: Programs & Events

*All programs & events are free*

Wednesdays

9:00AM – 12:00PM

Health for Two Educational Program

Tuesdays

Jan. 14th - March 18th

2:00PM – 3:30PM

Music Movement and Game:

You are registering for: Music, Movement and Game

Primary Caregiver Contact Information:

Secondary Caregiver Contact Information (If Attending):

General Information

Youth (Ages 0-5):

Youth #1 :

Youth #2:

Youth #3:

Consent

Storytelling:

You are registering for: Storytelling

Primary Caregiver Contact Information:

Secondary Caregiver Contact Information (If Attending):

General Information

Youth (Ages 0-5):

Youth #1 :

Youth #2:

Youth #3:

Consent

People in Our Neighborhood:

You are registering for: People in Our Neighborhood

Primary Caregiver Contact Information:

Secondary Caregiver Contact Information (If Attending):

General Information

Youth (Ages 0-5):

Youth #1 :

Youth #2:

Youth #3:

Consent

Connecting with Our Land:

You are registering for: Connecting with Our Land

Primary Caregiver Contact Information:

Secondary Caregiver Contact Information (If Attending):

General Information

Youth (Ages 0-5):

Youth #1 :

Youth #2:

Youth #3:

Consent

Being with Family ECD Program

Music Movement and Game

Storytelling

People in Our Neighborhood

Connecting with Our Land

Questions? Reach us at 780-481-3451 or kikosewin@bentarrow.ca

Contact Kikosewin Family Resource Network

CONTACT

PROGRAMS

GET INVOLVED

STAY UP-TO-DATE

The Bent Arrow Newsletter

All programs & events are free