Urban Butterflies Sign Up Information

Urban Butterflies is a group for Indigenous children and youth supported by Child and Family Service, including Youth in Care, Out of Care Options and Family Preservation. We provide youth with unique and fun opportunities to work and learn cultural art and dance, learn about their spirituality and gain skills to survive emotional pain associated with living in foster care away from their family. We aim to create a setting where they can learn skills to be self-reliant and know where to go for help and support. The Urban Butterflies program was founded by Joy Chalmers (1953-2021)

Child's Name*

First NameLast Name

Child's pronouns/Gender identity

Indigeneity: Child's Nation and Community (i.e. Dakelh-Carrier from Cheslatta, Squamish from Capilano, etc. We understand this information is not always known, please share as much detail as possible. This information is used to personalize teachings and shared with our Language department so that we may scout for Indigenous language teachers to share teachings for each child.)

Child's Date of Birth*

Date

Please note any of the Child's Allergies or Dietary Restrictions

Are you the Primary Caregiver? If yes, please add your name.*

First NameLast Name

Primary Caregiver Phone Number

Please enter a valid phone number.

Primary Caregiver Email

example@example.com

Primary Caregiver Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Please provide the name and contact information (with permission) of the person that we should notify when we have a workshop/event and want to invite the child to take part, as well as their relationship to the child.

Are you able to share some of the interests of the child, including their favourite sports/activity, favourite food, favourite book, favourite animal, favourite colour? We try our best to personalize birthday gifts for the children and will use this information to form future programming for the Urban Butterflies program.

Is the child in foster care? (If in temporary care, or respite care, please select "Yes" and fill out the Social Worker information)

YesNoI don't know

Social Worker Name (if applicable)

First NameLast Name

Social Worker Phone Number

Please enter a valid phone number.

Social Worker Email

example@example.com

Emergency Contact Name

First NameLast Name

Emergency Contact Phone

Please enter a valid phone number.

Emergency Contact Email

example@example.com