Learning 2Gether Program Registration Form
For further program information, please visit our website https://ideaworks.mohawkcollege.ca/resources/learning-2gether-program/
Mohawk College Student-Caregiver Information
Your Name
*
First Name
Last Name
Primary Phone Number
*
Format: (000) 000-0000.
Email Address (please use Mohawk Email)
*
example@example.com
Please enter your Mohawk Student ID
What type of study support(s) would you like?
*
Quiet Study
Math support
Literacy support
Conversational Practice
Which program(s) would you like to attend?
*
Wednesdays at Mohawk Library Fennel Campus 4:30pm-6:30pm
Thursdays at Terryberry Library 4:30pm-6:30pm
How many children will be attending the program with you?
*
1
2
3
4
By selecting 'I agree' on this form, I give permission to Learning 2Gether to use any photos or videos taken of me and/or my child/dependent while participating in the Learning 2Gether program. I understand that the photos/videos may be used for Learning 2Gether publicity and/or reproduction purposes as well as social media.
*
I agree
I do not agree
By signing below, I confirm that I have read and agree to the media release terms outlined above.
*
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Child 1
Please fill out the information listed below for each child that will be attending the program with you.
Name of child
*
Age of child
*
Please note that children under 24 months may be declined at the discretion of the ECE team.
What language(s) does the child that is attending with you speak?
*
Is there anything that we should know about the child attending the program with you to help us provide the best care for them (ex. Experience with childcare, interests or hobbies)?
*
Does the child that will be attending with you have any medial conditions, diagnoses and/or allergies that the staff should be aware of?
*
If yes, please list: Condition, reaction, if an epi-pen/medication is required, if so where is it kept, any additional comments. Disclaimer: Learning 2Gether staff are not permitted to administer medications to children
*
If the child attending the program with you needs to use the washroom, would you like the staff to bring them, or would you like us to come get you? Parents/guardians will be responsible for diaper changing support
*
Independent
With a staff
With a caregiver (includes children wearing diapers)
At Terryberry Library, some programming, such as Storytime, will be open to the public. Learning 2Gether staff will always be present with the children. However, if you would like to stay with your child during this portion of the program, you are welcome to do so. Would you like us to come get you when programming that is open to the public occurs?
*
Yes
No
We will be providing nut-free snacks and dinner. Is your child permitted to have snacks and dinner?
*
Yes
No
Please indicate any dietary restrictions:
Please attach an image of the child that will be attending the program with you. This will be used to assist with check in/check out.
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Child 2
Please fill out the information listed below for each child that will be attending the program with you (if you do not have multiple children attending the program with you, you may skip this section.
Name of Child
Age of child
What language(s) does the child that is attending with you speak?
Is there anything that we should know about the child attending the program with you to help us provide the best care for them (ex. Experience with childcare, interests or hobbies)?
Does the child that will be attending with you have any medial conditions and/or allergies that the staff should be aware of?
If yes, please list: Condition, reaction, if an epi-pen/medication is required, if so where is it kept, any additional comments. Disclaimer: Learning 2Gether staff are not permitted to administer medications to children
At Terryberry Library, some programming, such as Storytime, will be open to the public. Learning 2Gether staff will always be present with the children. However, if you would like to stay with your child during this portion of the program, you are welcome to step away from tutoring to do so. Would you like us to come get you when programming that is open to the public occurs?
Yes
No
If the child attending the program with you needs to use the washroom, would you like the staff to bring them, or would you like us to come get you? Parents/guardians will be responsible for diaper changing support
Independent
With a staff
With a caregiver (includes children wearing diapers)
We will be providing nut-free snacks and dinner. Is your child permitted to have snacks and dinner?
Yes
No
Please indicate any dietary restrictions:
Please attach an image of the child that will be attending the program with you. This will be used to assist with check in/check out.
Browse Files
Drag and drop files here
Choose a file
Cancel
of
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Child 3
Please fill out the information listed below for each child that will be attending the program with you (if you do not have multiple children attending the program with you, you may skip this section.
Name of Child
Age of child
What language(s) does the child that is attending with you speak?
Is there anything that we should know about the child attending the program with you to help us provide the best care for them (ex. Experience with childcare, interests or hobbies)?
Does the child that will be attending with you have any medial conditions and/or allergies that the staff should be aware of?
If yes, please list: Condition, reaction, if an epi-pen/medication is required, if so where is it kept, any additional comments. Disclaimer: Learning 2Gether staff are not permitted to administer medications to children
At Terryberry Library, some programming, such as Storytime, will be open to the public. Learning 2Gether staff will always be present with the children. However, if you would like to stay with your child during this portion of the program, you are welcome to step away from tutoring to do so. Would you like us to come get you when programming that is open to the public occurs?
Yes
No
If the child attending the program with you needs to use the washroom, would you like the staff to bring them, or would you like us to come get you? Parents/guardians will be responsible for diaper changing support
Independent
With a staff
With a caregiver (includes children wearing diapers)
We will be providing nut-free snacks and dinner. Is your child permitted to have snacks and dinner?
Yes
No
Please indicate any dietary restrictions:
Please attach an image of the child that will be attending the program with you. This will be used to assist with check in/check out.
Browse Files
Drag and drop files here
Choose a file
Cancel
of
Back
Next
Child 4
Please fill out the information listed below for each child that will be attending the program with you (if you do not have multiple children attending the program with you, you may skip this section.
Name of Child
Age of child
What language(s) does the child that is attending with you speak?
Is there anything that we should know about the child attending the program with you to help us provide the best care for them (ex. Experience with childcare, interests or hobbies)?
Does the child that will be attending with you have any medial conditions and/or allergies that the staff should be aware of?
If yes, please list: Condition, reaction, if an epi-pen/medication is required, if so where is it kept, any additional comments. Disclaimer: Learning 2Gether staff are not permitted to administer medications to children
At Terryberry Library, some programming, such as Storytime, will be open to the public. Learning 2Gether staff will always be present with the children. However, if you would like to stay with your child during this portion of the program, you are welcome to step away from tutoring to do so. Would you like us to come get you when programming that is open to the public occurs?
Yes
No
If the child attending the program with you needs to use the washroom, would you like the staff to bring them, or would you like us to come get you? Parents/guardians will be responsible for diaper changing support
Independent
With a staff
With a caregiver (includes children wearing diapers)
We will be providing nut-free snacks and dinner. Is your child permitted to have snacks and dinner?
Yes
No
Please indicate any dietary restrictions:
Please attach an image of the child that will be attending the program with you. This will be used to assist with check in/check out.
Browse Files
Drag and drop files here
Choose a file
Cancel
of
Back
Next
Research Study
Would you like to be contacted regarding participating in the Research Study Portion of the Learning 2Gether program? Please Note: Participation in the research study does not effect participation in the program
*
Yes
No
Registration
If you do not already have an active Hamilton Public Library card, would you like us to support you in registering for one?
*
Yes
No
If you have any further questions or concerns, please contact the Educational Program Coordinator at jessica.walker5@mohawkcollege.ca
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