Papa Bears Drop-In (Horizon)

Thank you for attending Papa Bears Drop-In. Please submit this form to confirm your attendance at our Drop-In.

Welcome to Papa Bears

Has your family attended Papa Bears Drop-In in the last 12 months?(Required)

Yes

Father's Information

Name(Required)

First Last

Residential Community(Required)

What community do you live in?

Adult's Gender(Required)

Date of Birth(Required)

Phone(Required)

Email(Required)

Attending Family Members

Who is joining you today at Papa Bears?

Add another adult?(Required)

Yes – Add Adult

How many children came with you today?(Required)

Adult 2 Information

Adult 2's Name(Required)

First Last

Adult 2's Gender(Required)

Adult 2's Birthdate(Required)

Adult 2's Phone(Required)

Adult 2's Email(Required)

Child 1 Information

Child 1's Name(Required)

First Last

Child 1's Gender(Required)

Child 1's Birthdate(Required)

Child 2 Information

Child 2's Name(Required)

First Last

Child 2's Gender(Required)

Child 2's Birthdate(Required)

Child 3 Information

Child 3's Name(Required)

First Last

Child 3's Gender(Required)

Child 3's Birthdate(Required)

Funders' Questions

Address(Required)

Street Address City Province Postal Code

Were you born in Canada?(Required)

Yes

How many years have you lived in Canada?(Required)

Less than 3 years

3-5 years

6-10 years

+11 years

Where were you born?(Required)

Are you Indigenous?(Required)

Yes

Are you Francophone?(Required)

Yes

Highest level of Education Completed?(Required)

Prefer no to say

Some High School

High School

University

Vocational/Community College

In the past 6 months, have you had difficulty paying for essential expenses such as housing, groceries, transportation, or utilities?(Required)

Yes

Is English your primary language?(Required)

Yes

What is your primary language?(Required)

How did you hear about Families Matter?(Required)

Emergency Contact Name(Required)

First Last

Emergency Contact's Phone Number(Required)

Additional Information

Please let us know if there are any information about your family we should be aware of:

Examples: dietary restrictions or food allergies

Welcome to Papa Bears

Father's Information

Attending Family Members

Adult 2 Information

Child 1 Information

Child 2 Information

Child 3 Information

Funders' Questions

Additional Information

Families Matter

Horizon / Admin Centre

Midnapore Family Centre