Airdrie Ages and Stages Birthday Party

Name *

First Name

Last Name

Phone *

(###)

###

####

Address *

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Were you born in Canada? *

Yes

No

If "No", how long have you lived here? *

Not applicable

0 to 3 years

3 years or more

If "NO", did you enter Canada as an immigrant or refugee? *

Yes

No

Are you an Indigenous person, that is, First Nations, Metis or Inuit? *

Yes

No

Are you Francophone?

Yes

No

Emergency Contact *

First Name

Last Name

Emergency Phone *

(###)

###

####

Child's name (#1)

First Name

Last Name

Child's gender (#1)

Male

Female

Your relationship to child (#1)

Parent

Caregiver

Was your child born in Canada? (#1)

Yes

No

If "NO", how long has your child lived here? (#1)

Not applicable

0 to 3 years

3 years or more

If "NO", did you enter Canada as an immigrant or refugee? (#1)

Yes

No

Is your child an Indigenous person, that is, First Nations, Metis or Inuit? (#1)

Yes

No

Is your child Francophone? (#1)

Yes

No

Child's name (#2)

First Name

Last Name

Child's gender (#2)

Male

Female

Your relationship to child (#2)

Parent

Caregiver

Was your child born in Canada? (#2)

Yes

No

If "NO", how long has your child lived here? (#2)

Not applicable

0 to 3 years

3 years or more

If "NO", did you enter Canada as an immigrant or refugee? (#2)

Yes

No

Is your child an Indigenous person, that is, First Nations, Metis or Inuit? (#2)

Yes

No

Is your child Francophone? (#2)

Yes

No

Child's name (#3)

First Name

Last Name

Child's gender (#3)

Male

Female

Your relationship to child (#3)

Parent

Caregiver

Was your child born in Canada? (#3)

Yes

No

If "NO", how long has your child lived here? (#3)

Not applicable

0 to 3 years

3 years or more

If "NO", did you enter Canada as an immigrant or refugee? (#3)

Yes

No

Is your child an Indigenous person, that is, First Nations, Metis or Inuit? (#3)

Yes

No

Is your child Francophone? (#3)

Yes

No

Would you like to receive email notifications of our programs and events? *

Yes

No