Youth Talk

2023-2024 Action for Healthy Communities Youth Talk

Action for Healthy Communities offers FREE programs to help immigrant youth to improve their life skills, to connect to community resources and information, and to stay connected with their peers and mentors. Some of our activities include conversation circles, art and craft, physical wellness, soccer club, volunteering, etc.
Programs*

Online Youth Talk /Wednesdays for 12-20 years old ,5-6.30 PMIn person Youth Talk /Thursdays 5-7 pm pm at Castle Downs Public LibraryIn person Youth Talk / Fridays 3.30-5 pm at Londonderry Public LibraryIn person Youth Talk/Mondays 5-6.30 pm at Clareview Public Library (Starts on September 18)
Student Information
Full Name*

First NameLast Name
Date of Birth*

DayMonthYear
Gender*
Mailing Address *

Street Address

Address Line 2

CityProvince

Postal Code
Email Address*
example@example.com
Phone Number*
Country of Origin*
Languages Spoken (Other than English)
Please provide the name of your school
Citizenship Information
Current Status ( please check one )*
Provide client ID number; (0000-0000, or 00-0000-0000,)*
Programs
Click the video below to learn more about our programs.
FOIP
Parents/Guardians Consent

Students who are over 18 years old can sign this form.
The information you provide to us will be used for the purpose of program evaluation, statistics, communication, planning, and reports to funders.This program is funded by IRCC(Immigration, Refugees and Citizenship Canada) to help immigrants, including refugees to settle in Canada. IRCC collects personal information to better understand newcomers needs.

We keep your personal information confidential and will not be used for any other purpose other than described above without your consent.

Collected information is protected from unauthorized access, collection, use and disclosure unless we are obliged or permitted by law to disclose it.

Questions regarding the collection of personal information can be directed to the Program Manager, sherry.park@a4hc.ca.
Photography & Media release

Photography & Media Release: I hereby give permission for me/my child/my projects/my child’s projects to be photographed/filmed by Action for Healthy Communities. I understand the photos/films will be used for promotion, sharing purposes and/or reports to our donors and for promotional purposes including flyers, brochures, newspapers, websites, and social media. I understand that although my child’s photograph/film/projects may be used for advertising, I do not expect compensation and that all photos/film/projects are the property of AHC and its affiliates.
DISCLAIMER AND WAIVER

I acknowledge that I am aware of, and accept the inherent physical risks and the other possible risks, dangers, and hazards associated with being a participant. These risks include but are not limited to all manner of injuries, broken, damaged or lost belongings and transmission of diseases (including Covid-19) in various ways and types from contact with other participants. I understand that Action for Healthy Communities (AHC) (employees, facilitators, and volunteers) are not responsible for any injury, loss or damage of any kind sustained by participants during the program or after the program day has ended. I understand that the rules and regulations are designed for the safety and protection of participants and hereby agree to follow /inform (my child) of the importance of abiding by the rules and regulations set down by Action for Healthy Communities.
Name *
Todays Date*

MonthDayYear
Date
Signature (parent/guardian must sign if participant is under the age of 18 years old)(Parents or guardian's /over 18 yrs old student)*

Clear
Should be Empty:

2023-2024 Action for Healthy Communities Youth Talk

Student Information

Citizenship Information

Programs

FOIP

Parents/Guardians Consent