Booking an Appointment with Immigrant Services at EarlyON | Oak Creek
Thank you for your interest in booking an appointment with Immigrant Services at EarlyON Oak Creek. The information you share below will be shared with Immigrant Services at the YMCA of Three Rivers. The information collected is private and confidential and will be used by Immigrant Services at the YMCA of Three Rivers under the terms and conditions outlined in their confidentiality statement. Outside of the conditions outlined in the confidentiality statement, Immigrant Services at the YMCA of Three Rivers will not share it with anybody without your consent, except to protect life or safety or when permitted by law.
Adult Name
*
First Name
Last Name
Child 1 Name
First Name
Last Name
Child Birthdate
-
Month
-
Day
Year
Date
Gender
Female
Male
Non-Binary
Transgender
Unknown
Other
Child 2 Name
First Name
Last Name
Child Birthdate
-
Month
-
Day
Year
Date
Gender
Female
Male
Non-Binary
Transgender
Unknown
Other
Child 3 Name
First Name
Last Name
Child Birthdate
-
Month
-
Day
Year
Date
Gender
Female
Male
Non-Binary
Transgender
Unknown
Other
Relationship to the Child or Children
Caregiver
Legal Guardian
None of the above
1. What is your KEyON QR code number? (number on the back of your KEyON tag). If you do not have a KEyON tag, email us at earlyyearsinfo@ytr.ymca.ca to start the process. A KEyON tag is not required to book this consultation.
2. Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
3. Phone Number
*
Please enter a valid phone number.
4. Phone Type
*
Home
Cell
Other
5. Email
*
example@example.com
6. What is your current Immigration Status
*
1. Permanent Resident
2. Temporary Resident (Visitor, Study or Work Permit)
3. Refugee Claimant
4. Convention Refugee
5. Naturalized Canadian Citizen (obtained the Canadian Citizenship Status through the application process with Immigration Refugee Citizenship Canada)
7. What you are hoping to talk with the Immigrant Service Worker about?
*
8. Do you need an interpreter for your appointment? If so, what language do you require?
*
9. Which date would you like to book? (Please choose one only)
*
10. The child does not need to attend the appointment. EarlyON professionals are able to provide childminding for up to two children ages 18 months and up during your appointment if requested by 12:00pm one business day before the appointment. Do you need childminding during your appointment?
*
Yes, I require childminding during my appointment.
No, I will not be bringing my child(ren).
If yes, please indicate the names and age(s) of the child(ren) requiring supervision.
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