Peer Mentor Training Registration Form

Peer Mentor Training Registration
PEER MENTOR TRAINING!

Peer Mentor Training is a fun and supportive program designed to help newcomer youth build leadership and mentorship skills while connecting with others. Through interactive games, group activities, and hands-on learning, participants will gain confidence, make new friends, and develop important life skills.

Please note: This training is mainly for the Summer WIN/NOW camp, and all Peer Mentors must be available to attend the camp on Tuesday, August 18 & Wednesday, August 19 from approximaetly 9:00 AM - 4:00 PM.

We can't wait to see you there!
WHO

Permanent Resident Youth in grades 10-12
WHEN

Friday, August 7, 2026 Time: 10:00 AM – 2:00 PM
WHERE

CBFY Main Office - Floor 15 910 7 Ave SW, Calgary, AB T2P 3N8
Need assistance or have questions?

For more information, please contact: - Chelsea Wolfe📞 403-990-2931✉️ CWolfe@cbfy.ca
PARTICIPANT INFORMATION
Participant Name

First NameLast Name
Date of Birth

MonthDayYear
MM-DD-YYYY
Gender
Name of Current School
Grade entering in September 2026
Country of Birth
Country of Origin/Ethnicity
First Spoken Language
Immigration Status
Unique Client Identifier (UCI)
If citizen, put 0. Please look at your landing documents for UCI number. See the photo to the right for an example.
Alberta Health Card Number
Allergies and/or Medications
(Example: gluten, dairy, peanuts, etc.)
Dietary Restriction

Other
Home Address

Street Address

Street Address Line 2

CityState / Province
Do you need any extra support or accommodations to fully participate in this program, such as disability, impairment, or ongoing health condition(s)?
If yes, please let us know how we can support. If no, please write N/A.

PARENT/GUARDIAN INFORMATION
Parent/Guardian #1 Name

First NameLast Name
Relationship to Participant
Parent Guardian #1 Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Parent/Guardian #1 Email
example@example.com
Preferred Language of Service
Parent/Guardian #2 Name

First NameLast Name
Relationship to Participant
Parent Guardian #2 Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Parent/Guardian #2 Email
example@example.com
Preferred Language of Service
EMERGENCY CONTACT INFORMATION
Emergency Contact Name

First NameLast Name
Relationship to Participant
Emergency Contact Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Preferred Language of Service
DISMISSAL DETAILS
How will your child go home?
If being picked up, who will pick up your child? If they are walking home or taking transit, please confirm that below.
Additional pick up people
CONFIRMATION

CONSENT FORM
Consent to Share Information with Child’s School and Other Stakeholders:
The CBFY offers support to families, and their school-aged children enrolled in the schools. In order to participate in any of the programs, CBFY requests’ participants to provide important information. The CBFY will also refer your child(ren) to other agencies, as needed, and personal information will be shared with them. To protect students and their families' privacy, CBFY requires parental consent to comply with the Freedom of Information and Protection of Privacy Act (FOIP). This authorization will allow CBFY to access the necessary information to provide settlement support and services, and to share it with other agencies as needed.
Consent to Release Information and Possible Future Research to Immigration Refugee Citizenship Canada:
The CBFY Programs are funded by Immigration, Refugees and Citizenship Canada (IRCC). To support your ongoing settlement needs, IRCC would like to request your permission to contact you in the future. CBFY will protect any information collected from you under the authority of Alberta's Freedom of Information and Protection of Privacy Act (FOIP). I hereby give consent for IRCC to obtain information to support research and funding programs that serve newcomer families and youth in Canada.
Consent for Media Release
CBFY may film, photograph, produce electronic images, and provide the opportunity for my child(ren) to participate in social media coverage (e.g., Facebook, Instagram, and Twitter) of our programs or media interviews.
Emergency Consent Acknowledgement
In case of an emergency or illness, CBFY will make every effort to contact the parents/guardians. In the event that CBFY cannot make contact in a timely manner, I agree that a qualified medical professional may attend to my child(ren).
Liability Waiver
I accept that as the child’s legal parent/guardian I give permission for my child(ren) to participate in the peer mentor activities, including 2-day WIN/NOW camp, and release CBFY of all responsibility and liability with respect to any and all of the activities.
SIGNATURE

Based upon my understanding of the activity and the hazards identified above, I give permission for my child(ren) to participate in WIN/NOW.
Signature of Parent/Guardian:

First NameLast Name
Today's Date:

MonthDayYear
Date
Should be Empty:

Peer Mentor Training Registration

WHO

WHEN

WHERE

Need assistance or have questions?

PARTICIPANT INFORMATION

PARENT/GUARDIAN INFORMATION

EMERGENCY CONTACT INFORMATION

DISMISSAL DETAILS

CONSENT FORM

Consent to Share Information with Child’s School and Other Stakeholders:

Consent to Release Information and Possible Future Research to Immigration Refugee Citizenship Canada:

Consent for Media Release

Emergency Consent Acknowledgement

Liability Waiver

SIGNATURE