Join our 2021 AFTER-SCHOOL PROGRAM!

Parent Full Name*

Student Full Name*

Current School and Grade (2021 - 2022)*

Student's Age and Gender*

Parent's Home Telephone and Cell Phone Number*

Home Address (Street address, City, Province, Postal code)*

Which community are you from (Regent, Moss, Rivertowne, or other)*

Email*

Student's Primary Email:*

Does your child(ren) have any known allergies or food allergies/dietary restrictions? *

Are you in need of any resources? (Working devices, healthcare, food, transportation fare, etc.)

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Please email us directly at YEA@regentparkchc.org

Our office is now closed due to COVID-19. We will resume in-person operation based on the guidance from Public Health authorities.