Registration / Checkout

Parent(s) Information

First Name

Last Name

Phone Number

Adult's Gender

Adult's Date of Birth

Have you previously taken a program at Families Matter? Yes No

How did you hear about us?

Address Information

Address

Apartment, Suite, Etc.

City

Postal Code

Country

Community

Parent & Child Funder-Required Info

Would you like to add another Adult Participant? Selecting Yes will prompt our team to confirm this with you. * Yes No

Are you a Francophone? * Yes No

Highest level of education completed?

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

Is English your primary language? * Yes No

Child Participant Information

First Name

Last Name

Child's Gender

Child's Date of Birth

Is there anything you would like to share about your child that will help us make their experience with us positive? (Example: allergies, dietary restrictions, medical needs, temperament)