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Unique Get
Together Society
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REGISTRATION
FORM
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First Name
Last Name
Home or Cell Phone
Work Phone
*required information
STATUS INFORMATION*
First Nations
Metis
Inuit
Non-status
Parent or Child's Status Number
APPLICANTS INFORMATION*
Address
Email
WHAT ARE YOU REGISTERING FOR?*
SUPPORT PROGRAM
Indigenous Focusing Oriented Therapy
Indigenous Youth Addiction Program
Trauma Therapy Program
Services for Children with Special Needs Program
Family Strength Program
Employment for People with Disabilities Program
Respite Program
Addiction Relief Program
Chilliwack After School Program
Vancouver After School Program
CAMPS & ACTIVITIES
Chilliwack Spring Camp
Chilliwack Summer Camp
Vancouver Spring Camp
Vancouver Summer Camp
Kamloops Summer Culture Camp
Kamloops Culture Spring Camp
Badminton Camp w/ ISPARC
Summmer Camp
Basketball
Track & Field
Blind Tennis
Trauma Informed Yoga
Kayaking
Dreamcatcher Workshop
On The Land Outdoor Adventures
FACILITY
UGTS Daycare
Do you need transportation?
YES
NO
If you are applying on behalf of a minor, please complete the following:
PARENT OR LEGAL GUARDIAN INFORMATION
First Name
Last Name
Home or Cell Phone
Work Phone
Email
Address
CHILD'S INFORMATION
First Name
Last Name
Address
Preferred Name & Pronouns
AUTHORIZED PERSONS FOR PICK UP
Phone Number
Phone Number
NOT AUTHORIZED PERSONS FOR PICK UP
Phone Number
Phone Number
Is there a custody agreement in place?
YES
NO
If yes, upload here
Upload File
Upload supported file (Max 15MB)
Gender
Full Name
Full Name
Relation to Child
Relation to Child
Full Name
Full Name
Relation to Child
Relation to Child
DOB (mm/dd/yy)
APPLICANT OR CHILD'S EMERGENCY HEALTH INFORMATION
Family Doctor or Clinic Phone
I authorize the staff at the child care centre to call a medical practioner or ambulance in the case of accident or illness of my child(ren), if the parent cannot immediately be reached. *
Health Care Number
Family Doctor or Preferred Clinic
APPLICANT OR CHILD'S EMERGENCY CONTACT INFORMATION
Alternate person to call and pick up in case of an emergency
Phone Number
Full Name
Relation to Child
CHILD'S IMMUNIZATION INFORMATION
Is your child up to date on their immunizations?
YES
NO
NOT IMMUNIZED
Type of Immunization
Pertussis (mm/dd/yy)
Tetanus (mm/dd/yy)
Polio (mm/dd/yy)
HIB (mm/dd/yy)
MMR (measles, mumps, rubella) (mm/dd/yy)
Covid 19 (mm/dd/yy)
CHILD'S MEDICATION
Additional Medications
Type of Medication
Reason for Medication
Type of Medication
Reason for Medication
Type of Medication
Reason for Medication
CHILD'S ALLERGIES
Additional Allergies
Allergy
Treatment
Allergy
Treatment
Allergy
Treatment
Additional Comments
REGISTER
Thanks for Registering at UGTS! We will be in touch
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