EcoCooks Club - Kelowna WINTER 2024/25 Registration Form

Kelowna WINTER 2024/25 Registration

Willow Park Church
Program Information:
- Program location: Willow Park Church, 439 Hwy 33, Kelowna
- Program fee: Pay-What-You-Can, at a sliding scale of $0 to $100.
- Payment method: If you are paying $0 or using a credit card for payment, please proceed with the registration below. If you require a different payment method, please email bdemelo@uncf.ca
Has your child participated in the full 8-workshop EcoCooks Club program in the past?*

NoYesOther
If "Other", please describe
We are sorry!

Unfortunately, past participants are not able to take the program again, however we are working diligently on our new alumni program which they will be able to join. Stay tuned for more info!
Which program are you registering for?*
Please click here to join the Waitlist if there are 0 spaces available, or if you are interested in the future programs dates!
Participant Name *

First NameLast Name
Participant Preferred Name
Participant Birth Date *

MonthDayYear
Eligible Age is between 9-13 while the program is in progress
Participant Pronouns *
If "Other", please describe
Participant School
Participant Address*

Street Address

Street Address Line 2

CityProvince

Postal Code
Parent/Guardian Name (Main Contact)*

First NameLast Name
Parent/Guardian Relationship to Participant*
Parent/Guardian Phone Number*
Please enter a valid phone number.
Parent/Guardian Email Address*
example@example.com
We will be sending information throughout the program to the Main Contact's above email address. If there are other Parents/Guardians we should also be communicating with, please provide their email address:
example@example.com
Emergency Contact Name*

First NameLast Name
Emergency Contact Phone Number*
Please enter a valid phone number.
Emergency Contact Relationship to Participant*
At the end of each session, the Participant ...*
If "Other", please describe

Please list any medical, physical, social or behavioural supports that may be needed for participation.
Does the Participant take any medication that we should be aware of? *
Does the Participant have any dietary restrictions? *
Does the Participant have any allergies (food, skin, medication, environmental)? *
Note: Please let us know if anything changes during the program (e.g. you discover a new food allergy) by emailing or calling your program Educator
Has the Participant ever had an anaphylactic reaction? *
Does the Participant carry an EpiPen?*
Tell us about the Participant's relationship with food e.g. Are they a picky eater? Do they have any specific likes or dislikes?*
How did you hear about EcoCooks Club?*
Would you like to be an on-call EcoCooks Volunteer? We will only contact you if we need help for the program.
Consent & Waivers (Optional)

I hereby consent for my child to attend EcoCooks field trips. Advanced notice will be given.I hereby consent for EcoCooks, and all associated and related entities, to use my child’s photographs, audio and video recordings for any and all marketing, public relations and promotional purposes, which they may, in their sole and absolute discretion, deem appropriate. Photos and recordings may be used to promote for-profit entities that partner with EcoCooks. Withdrawal of consent can be withdrawn at any time, when practicable. Withdrawal of consent is not retroactive, therefore EcoCooks, and all associated and related entities, is authorized to use photos and recordings as indicated above during the time in which consent has been provided. In the case of publication, the removal of your child's personal information or intellectual property may not be achievable if consent is withdrawn after publication has taken place.Yes, please subscribe my email address to get delicious planet-positive recipes, zero-waste tips, latest updates, program and event notifications from EcoCooks.
Consent & Waivers (Mandatory)
By signing below, I consent to the following:
- I agree to fill out pre-program and post-program surveys to provide important and timely feedback that EcoCooks will use to measure impact and continue to improve.
- I will not allow my child to attend if they are ill. I also agree to inform EcoCooks immediately if my child has a communicable disease and/or COVID-19.
- My child will commit to attend all workshops, as long as they are able, as this program is based on ‘scaffolding learning’, where participants are building on the previous workshop's learnings.
- I give permission for EcoCooks to obtain emergency medical treatment for my child, if necessary.
- I waive any claim on EcoCooks, its associated and related entities, its volunteers and staff, of any liability for any injury, loss of or damage to my or my child’s property, while involved in any activity associated with EcoCooks.
- I recognize that my chid is expected to show respect for the program, property, rules, equipment, staff/volunteers, themselves and for other participants. Failing to follow expectations and/or displaying unacceptable behaviour causing safety concerns, may result in their removal from the program.
- If my child must voluntarily withdraw from the program, I agree to inform EcoCooks as soon as possible to allow for another child the opportunity to participate.
Parent/Guardian Signature*

Clear
Date*

MonthDayYear
Date
Proceed to the next page to add your payment details and submit your completed registration.

Payment & Submit your completed registration
- Our Program Fee is Pay-What-You-Can, at a sliding scale of $0 to $100.
- As a non-profit program, we rely on donations and community support to keep our program accessible. If you are able to pay it forward, please consider a separate tax-receiptable donation here.

EcoCooks Club Program fee: Enter in the amount you are able to pay (between $0 to $100)

CAD.

Credit Card Information (only fill out if paying a program fee)
First Name	Last Name
Credit Card Number	Security Code
Expiration Month	Expiration Year

The payment transaction will be posted on your credit card statement as from "UNBOUNDED CANADA FOUNDATI"
Should be Empty:

Kelowna WINTER 2024/25 Registration

Payment & Submit your completed registration