Movement and Lunchtime Stories
Move together. Eat together. Share your Canadian story.
Registrant Information
Full Name
*
First Name
Last Name
Please give us at least one way to reach you.
Email Address
example@example.com
Phone Number
Please enter a valid phone number.
Format: (000) 000-0000.
Age Group
*
Under 18
18 or older
If you are under 13, please ask a parent or guardian to fill out this form for you.
Because you are under 18, a parent or guardian will need to sign a consent form before you attend. We will contact you after you register.
Will you be one of the people attending?
*
Yes
No
Attendance and Group Size
How many people, including you, will be attending?
*
Please Select
1
2
3
4
5
Everyone listed on this form will attend the same date or dates you choose below.
How many people will be attending?
*
Please Select
1
2
3
4
5
Everyone listed on this form will attend the same date or dates you choose below.
Attendee Details
Enter details for the first person if different from above
Person 1
Name
*
First Name
Last Name
Age group
*
Under 18
18 or older
Person 2
Name
*
First Name
Last Name
Age group
*
Under 18
18 or older
Person 3
Name
*
First Name
Last Name
Age group
*
Under 18
18 or older
Person 4
Name
*
First Name
Last Name
Age group
*
Under 18
18 or older
Person 5
Name
*
First Name
Last Name
Age group
*
Under 18
18 or older
Session Selection and Notes
Which date or dates would you like to attend?
*
Saturday, October 10, 3:00 to 5:00 PM
Saturday, October 24, 3:00 to 5:00 PM
Saturday, November 14, 3:00 to 5:00 PM
Saturday, December 5, 3:00 to 5:00 PM
Do you have any dietary, accessibility, mobility, or participation needs we should know about?
We use this information only to plan food and set up the space. You do not need to share medical details.
How did you hear about this program?
Flyer or QR code
Facebook
CCRBH website
Northwood Community Centre
A community organization
Friend or family
Other
Which organization?
Other
CCRBH may contact me about this registration, consent forms, session reminders, and program feedback.
*
Yes
Send me updates about future CCRBH programs and events.
Yes
Request registration
Should be Empty: