Youth Job Readiness Summer Program Registration Form The personal information you are about to enter in this online form will be shared with collaborating organizations. "*" indicates required fields Step 1 of 2 50% Name* First Last Date of Birth* DD slash MM slash YYYY Age*Gender* Female Male Prefer not to say Other Are you a registered client with Employment Services?* Yes No Not Sure Briefly describe your professional background or career goals.* What is your CLB level?* UCI / PR Card Number:*Country of Origin*Select…AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCambodiaCameroonCanadaCape VerdeCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongo, Democratic Republic of theCongo, Republic of theCook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzech RepublicCôte d'IvoireDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatini (Swaziland)EthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacauMacedoniaMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth KoreaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRomaniaRussiaRwandaRéunionSaint BarthélemySaint HelenaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth GeorgiaSouth KoreaSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan Mayen IslandsSwedenSwitzerlandSyriaTaiwanTajikistanTanzaniaThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkeyTurkmenistanTurks and Caicos IslandsTuvaluUS Minor Outlying IslandsUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVenezuelaVietnamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabweÅland IslandsContact Number*Email* Home Address* Street Address Address Line 2 City ProvinceAlbertaBritish ColumbiaManitobaNew BrunswickNewfoundland and LabradorNorthwest TerritoriesNova ScotiaNunavutOntarioPrince Edward IslandQuebecSaskatchewanYukon Province Postal Code Emergency Contact Person* First Last Emergency Contact Number* Parent Consent FormParents Of Youth Under The Age Of 18 Must Read And Sign The Consent Below!Parent/Guardian's Name* First Last Parent/Guardian's Contact Number*Any pre-existing medical issues or allergies that may affect your child's participation?* Yes No Please Specify* I/We know that sufficient information has been provided by the Youth Worker with respect to the planned activity, duration, location, participants and supervision.* Yes No I/We understand that the rules and regulations established for the program are designed for the safety and protection of the participants and hereby undertake to inform and expect my child to abide by these rules and regulations.* Yes No I/We hereby give permission for photos and or videos of my child captured during the activity to be used by Regina Open Door Society in promotional materials through website, social media, newsletters, posters and publications waiving my rights of compensation or ownership thereto.* Yes No I/We hereby allow my child to be captured and or interviewed by the press in the event of a media coverage.* Yes No I/We consent to my child's in the program and I am aware of the risks of injury. These types of injuries may be minor or serious and may result from one's actions, or the inaction of others, or a combination of both. I consent to my child's participation in spite of such risks.* Yes No I/We acknowledge that it is my responsibility to advise Regina Open Door Society of any medical or other conditions that may affect my child's participation in the program.* Yes No In the event that my child requires medical attention, I consent to my child being transported to the nearest emergency facility including by ambulance if necessary, and accept that I am responsible for any costs of such service.* Yes No Parent/Guardian's consent/signed* Yes No Date Signed* DD slash MM slash YYYY
