Page 1 of 14

Program Registration

This form helps us get to know your child and understand what they need to feel safe, comfortable and supported at Chickadee. The information you share is kept private and is only used by our team to support your child and communicate with your family.

The form takes about 5–10 minutes to complete.

Child Information

Child's Full Name

*

Preferred Name (if different)

Child's Date of Birth:

*

Gender

Preferred Pronouns

Primary language spoken at home