Parents & Caregivers Programs & Events: Kikosewin Family Resource Network

Monday, April 14th

AM Session:

9:30 AM - 11:30 AM

PM Session:

1:00 PM - 3:00 PM

Beaded Red Dress Pin (AM)

Participant Contact Information:

First Name

Last Name

Date of Birth (M/D/Y)

Address

Address Line 1

Address Line 2

City

Province

Postal Code

Country

Email

Phone

Preferred Method of Contact

Best Time to Contact You

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

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)

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

I agree to allow Bent Arrow Traditional Healing Society to capture and use photographs and/or videos of me for promotional and storytelling purposes. I understand that these images may be used in print materials, social media, and other communications to share the work of Bent Arrow. I recognize that providing consent is voluntary, and I have the right to withdraw my consent at any time without consequence.

Yes, I give consent

No, I do not consent

Beaded Red Dress Pin (PM)

Participant Contact Information:

First Name

Last Name

Date of Birth (M/D/Y)

Address

Address Line 1

Address Line 2

City

Province

Postal Code

Country

Email

Phone

Preferred Method of Contact

Best Time to Contact You

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

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)

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

I agree to allow Bent Arrow Traditional Healing Society to capture and use photographs and/or videos of me for promotional and storytelling purposes. I understand that these images may be used in print materials, social media, and other communications to share the work of Bent Arrow. I recognize that providing consent is voluntary, and I have the right to withdraw my consent at any time without consequence.

Yes, I give consent

No, I do not consent

Location: Bent Arrow (Gym)

Programs for Parents & Caregivers