Clone of Learning Anishinaabemowin II Application

Full Name*

First NameLast Name

Birth Date*

MonthDayYear

Phone Number*

Area CodePhone Number

E-mail*

Gender*

FemaleMaleOther

Indigenous Declaration*

Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Please list additional children or adults participating. Click '+Add Row' for each additional person*

Emergency Contact*

First NameLast Name

Emergency Contact #*

Area CodePhone Number

Relationship*

Have you taken a beginner or intermediate Ojibwe class before?*

YesNo

Please share which programs you have taken before or where you learned to speak Ojibwe*

Why are you interested in learning Anishinaabemowin?*

Photo Consent: I do hereby consent and agree that Wii Chiiwaakanak Learning Centre and its partners have the right to take photographs, videotape, or digital recordings of me and or my child(ren) to use for the purpose of publication, promotion of future programs, or electronic/social media. I further consent that I or my child(ren)'s name and identity may be revealed therein or by descriptive text or commentary. I waive any rights, claims, or in whatever media used. I understand that there will be no financial or other remuneration for the photo or video.

I give consent for Wii Chiiwaakanak to take photographs of me and/or my child.*

YesNo

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