Events

After School Program (Lorette)

This program aims to help newcomers/immigrants integrate into canadian society, make new friends, and improve their english language skills. Non-immigrants/non-newcomers also welcome!

Every Friday starting December 17, 2021, 5-6 PM
Dawson Trail School gymnasium, Lorette

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This registration form is for a program/event led by the Settlement Workers In Schools (SWIS), who are employees of Eastman Immigrant Services (EIS) . EIS requests the following information for the purposes of data collection, to improve settlement programs in schools, and in case of an emergency.

Child's First Name^*

Child's Last Name^*

Child's Date of Birth

Gender^*

Male
Female

Manitoba Health Card (6 digit number)

Manitoba Health Card (9 digit number)

Address

Address Line 1 ^*

Address Line 2

City ^*

State or Region ^*

Zip ^*

Country of Origin^*

Date of Arrival in Canada^*

Status in Canada^*

UCI # (I.D. number on PR & Refugees Card)

Languages spoken at home^*

Parent/Guardian's First Name^*

Parent/Guardian's Last Name^*

Email^*

Phone Number (Mobile/cell preferred)^*

Parent's Status in Canada^*

Events^*

Photo Consent

I give Eastman Immigrant Services permission to take my picture today and/or at future programs and events. I understand that this picture may be used in brochures, on posters, on social media, or on the EIS website. My photo will not be sold for profit. In the future, if I change my mind about Eastman Immigrant Services using my photo, I can call Eastman Immigrant Services, and they will stop using my photo.^*

SWIS Program Participation Waiver

I, the parent or legal guardian of the aforementioned child, agree for my child to participate in the selected SWIS program and remain in the custody of an Eastman Immigrant Services (EIS) representative (including SWIS) while participating in the activities. I understand that there may be risks involved in the minor's participation of any activities organized by SWIS and/or EIS, and fully assume risks on his or her behalf. Also, if my child has an injury; a condition that will endanger his/her life; food allergy reaction; and/or pain if medical treatment is delayed, and if the EIS representative (including SWIS) has not been able to contact me, I appoint an EIS representative (including SWIS) to act for me and in my name to make decisions for my child concerning his/her: personal care, medical treatment, hospitalization, and/or health care. Once I have been contacted regarding my child's situation, this agreement is no longer valid. I will not hold EIS or SWIS representatives, the Steinbach Chamber of Commerce, or the volunteers responsible in the event of injury or death.

Indication of Agreement^*

I agree
I do not agree

Please type your first and last name indicating your agreement to the waiver.^*

Please add me to the EIS monthly e-newsletter list.^*