AHC STEM Club Registration 2025-2026

Action for Healthy Communities STEM Club 2025-2026 Registration

The Science, Technology, Engineering, and Mathematics (STEM) Club is an interactive, in-person program designed for children and youth. It offers a range of educational activities aimed at fostering interest in STEM. Each week, participants will explore STEM concepts through both theoretical lessons and hands-on activities related to that week’s theme. The Action for Healthy Community Children and Youth program is committed to supporting children and youth from priority groups, including those from economically disadvantaged backgrounds, Indigenous communities, newcomers, immigrants, and racialized groups. We are prioritizing children from these groups for this program.
Did your child attend this program during the last school year?

Yes.No, this is the first time registering this program.
I understand that this program focuses on children from groups experiencing specific challenges, including those from economically disadvantaged households, Indigenous communities, immigrants, refugees, and racialized groups. I believe my child is currently experiencing one or more of these challenges.*

Agree
PARTICIPANT INFORMATION (Child)
What school is your child in?*

Thorncliffe- Mondays 3:30-5:00Alex Janvier - Tuesdays 3:30-5:00Belmead- Tuesday 3:30 - 5:00St. Catherine-Wednesday 2:45-4:15Brightview- Wednesdays 3:40-5:00Athlone- Thursdays 12:30-2:00Inglewood- Thursdays 12:30-2:00
What grade is your child in?*

Grade 4Grade 5Grade 6
Child Name*

First NameLast Name
Child Date of Birth*

MonthDayYear
Home Address (The address is used to send important updates, meet funder reporting requirements, and gather geographic data for our programs.)*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Child Gender (This helps in program planning, staffing, and ensuring inclusivity and equity.)*

FemaleMaleNon-BinaryPrefer not to answerOther
Does this child consider themselves as Indigenous? (This helps in program planning, staffing, and ensuring inclusivity and equity.)*

YesNoPrefer not to answer
EMERGENCY CONTACT

This person will be reached in case of an emergency involving your child during the program. If your contact information changes, please notify us immediately.
Emergency Contact 1*
Emergency Contact 2*
PICKUP INFORMATION

Please list the names and contact information of individuals who are authorized to pick up your child from the program. If the authorized pickup persons are unavailable, please provide instructions for an alternative pickup arrangement. Please ensure you are on time to pick up your child at the time the session is finished. Late pickups will incur a fee.
How will your child typically go home after the STEM Session?*

I give permission for my child to walk home alone.They will be picked up.
If picked up, Who will pick your child up?
Please ensure you are on time to pick up your child at the time the session is finished. Late pickups will incur a fee.
RESIDENT STATUS

This information helps determine eligibility for priority consideration and is used for funding purposes.
Child Resident Status*

Permanent Resident (UCI Number)Refugee (UCI Number)Temporary Resident (UCI Number)Canadian CitizenOther
Where to find UCI - Examples
UCI number*
Country of origin*
Date arrived in Canada*

MonthDayYear
What language is mainly spoken at home?*
Preferred official language *

EnglishFrench
SUPPORT and ACCOMMODATION NEEDS

If your child requires one-on-one support or has special needs that our staff may not be equipped to manage, please let us know. We are committed to inclusivity and will assess whether the program can reasonably accommodate your child's needs through a discussion with you about specific requirements and available resources. If our program lacks the capacity to fully support your child’s needs, we will work with you to explore options and may refer you to other organizations that specialize in such care. Our priority is your child’s well-being, and we aim to provide support within our program’s capacity while ensuring safety and effective participation for all children.
Please provide details about any allergies, health concerns, or behavioral needs to help us ensure your child’s safety and a positive experience in the program. It is important that you disclose this information to enable us to offer appropriate support.*
NOTIFICATION OF COLLECTION OF PERSONAL INFORMATION

The Personal Information that you provide to Action for Healthy Communities (AHC) during the registration process, during the course of participation in any programs or services is collected, used, and disclosed for the purposes of assessing eligibility for programs and services, communication purposes, providing services, ensuring a safe and secure environment for all our participants, and for internal management purposes. Limited information may also be provided, according to existing funding and/or information sharing agreements, for the purpose of carrying out programs, activities, or policies (e.g., research, statistical analysis, etc.) or for receiving provincial and/or federal funding. For more information, please contact the AHC Privacy Officer at communications@a4hc.ca.
PRIVACY AND CONFIDENTIALITY COMMITMENT

Action for Healthy Communities (AHC) is committed to protecting the personal information of our clients. We collect personal information for purposes such as activity enrollment, emergency contacts, program assessment, communication, health and safety, quality improvement, and funding reports. The collected information will not be shared outside of AHC without your consent, except where required or permitted by law. We ensure that your information remains confidential and is handled with the highest level of care. When no longer needed, it will be securely disposed of in accordance with AHC’s retention guidelines and applicable standards.
PHOTOGRAPHY & MEDIA RELEASE

I hereby grant permission to Action for Healthy Communities (AHC) to photograph or film me, my child, my projects, or my child’s projects. I understand that these images and recordings may be used for promotional purposes, including flyers, brochures, newspapers, websites, social media, and reports to our donors and partners. I acknowledge that I will not receive compensation for the use of these photos, films, or projects. Additionally, I understand that all such materials will remain the property of AHC and its affiliates.
Photography & Media Release Consent (Consent should be made by the parent/guardian IF the participant is under 18 years old)*

Yes, I give my consent.No, I do not give my consent.
INFORMED CONSENT AND WAIVER
I acknowledge that I am aware of and accept the inherent physical risks and potential hazards associated with participation in the program. This includes the possibility of severe or fatal injuries, damage or loss of personal belongings, and the transmission of diseases, including COVID-19, through contact with others during the program.

I understand that Action for Healthy Communities (AHC), including its employees, facilitators, partners, and volunteers, is not responsible for any injury, loss, or damage sustained by participants during, before or after the program.

For Children’s Programs:
- I am responsible for arranging safe transportation to and from the program and for communicating with my child about pickup arrangements or walking home.
- I grant permission for AHC staff to take my child off-site for community walks, visits to spray parks, or other on-foot activities within the community.
- I understand and agree to follow the program’s rules and regulations, designed to ensure participant safety. I will inform my child of these rules and their importance.
- I recognize that disruptive or risky behaviors that endanger others may result in removal from the program.
- I acknowledge that it is my responsibility to evaluate the program's suitability for myself or my child.
Consent (Consent should be made by the parent/guardian if the participant is under 18 years old)*

I declare that I've carefully read, understood and agreed to the contents of the above.
Parent/Guardian's name *
Example: Jane Smith
Parent/Guardian's email.*
example@example.com
Parent Phone Number*
Please enter a valid phone number.
Thank you for registration!

We will contact you soon with the status of your registration. Please contact kevwe.dabor@a4hc.ca if you have any questions.
Follow us for program updates!
Should be Empty:

Action for Healthy Communities STEM Club 2025-2026 Registration

PARTICIPANT INFORMATION (Child)

EMERGENCY CONTACT

PICKUP INFORMATION

RESIDENT STATUS

Where to find UCI - Examples

SUPPORT and ACCOMMODATION NEEDS

NOTIFICATION OF COLLECTION OF PERSONAL INFORMATION

PRIVACY AND CONFIDENTIALITY COMMITMENT

PHOTOGRAPHY & MEDIA RELEASE

INFORMED CONSENT AND WAIVER

Thank you for registration!