Unpack N' Play Registration Form

Parent's Name

Email

Age range

Phone

Postal Code

For each child you are registering (including newborns and babies) please write their name/s and age/s

Zoom Session (you can indicate your facilitator preference in the comments section)

Please check if the following applies to you:

Indigenous‎ Single Parent‎ Low Income Family‎

What is your mobility status:

Non-migrants Internal Migrants (from within Canada) External Migrants (from outside of Canada)

How long have you lived in Canada?

Do you have any concerns about your family functioning (i.e. new baby, job loss, parents back to work, etc.)? How has your family been impacted by COVID-19? What challenges is your family facing, if any?

How do you feel City West could provide you the support you might need in regards to parenting/child development/family functioning/etc. What are you hoping to gain from the program?

Do you have any concerns about your child's health or development?

Comments
E.g. other days that would work for you, potential missing sessions, if you are expecting a baby during the 12 weeks of the program, facilitator preference, etc.