Family Literacy Registration Form
Fill out the form carefully for registration in one of our Family Literacy Programs
Courses
Please Select
Books for Babies -Lloydminster
Fun with Numbers -Lloydminster
Rhymes that Bind -Lloydminster
Indigenous Rhymes that Bind - Lloydminster
Family Literacy Course
Today's Date
Parent/Guardian Name
*
First Name
Middle Name
Last Name
Mailing Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
E-mail
*
example@example.com
Mobile Number
Phone Number
*
Work Number
Child's Name
*
First Name
Last Name
*
Year of Birth
Gender
Child's Name
First Name
Last Name
Year of Birth
Gender
Child's Name
First Name
Last Name
Year of Birth
Gender
Child's Name
First Name
Last Name
Year of Birth
Gender
Self Identification, if applicable
Please Select
First Nations
Metis
Inuit
Status in Canada
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Canadian Citizen
Permanent Resident
Temporary Foreign Worker
Refugee
Originating Country
How did you hear about us?
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Word of Mouth
LLCA Website
Other Website
LLCA Facebook page
Other Facebook page
LLCA Instagram
Newspaper Ad
Refund Policy
Refunds will be issued if a program is cancelled. Refunds will not be made after registration. Registration may be transferable to another person. Refunds may be made in the event of a personal emergency. Requests must be made in writing. $20 charge on all NSF cheques.
This personal information is collected for purposes of operating our education program pursuant to section 33(c) of the Freedom of Information and Protection of Privacy Act. If you have questions about this collection, please call: 780-875-5763
Social/Economical Barrier(s)
Travel Distance (kms)
Referred By
First Name
Last Name
I authorize Lloydminster Learning Council Association to use names, photos and testimonials for awareness and promotion on social media
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