English Language Support Program (ELS) 2nd/3rd iterations
STUDENT REGISTRATION FORM
We are now waitlisting students for this program.
The English Language Support Program is a free after-school English program for newcomer children in grades 4-7 who are new to Canada from Ukraine.
The program runs in-person at the Surrey City Centre Library
every Saturday from 11:00 am to 1:00 pm.
The upcoming iteration of this program consists of 8 sessions, once a week, from
January 27th to March 16th, 2024.
We have space for 15 children, on a first-come first-serve basis. If the program is full, you will be placed on a waitlist.
Program location:
Surrey City Centre Library (10350 University Dr, Surrey, BC V3T 4B8)
Q1 . I understand that this program runs in-person at the Surrey City Centre Library every Saturday from 11:00 am to 1:00 pm and confirm that my child will be present at all the sessions (if child is sick please notify us in advance)
Yes
No
Q2 . Student's Information
Student's First Name :
*
Student's Last Name :
*
Student's Birthdate (month/day/year) :
*
Student's Age :
*
Name of Student's School :
*
Language(s) Student Can Speak and Read in :
*
Q3 . Student's Gender
Select One...
female
male
x
prefer not to say
*
Q4 . Home Address (number, street, city, province and postal code)
*
Q5 . Parent / Guardian's Information
First name :
*
Last name :
*
Phone number (home or cell) :
*
Email :
*
First name (if more than one parent/guardian) :
Last name :
Phone number (home or cell) :
Email :
Q6 . Background Information
Has the family recently settled in Canada from Ukraine? (Yes/No) :
*
How long has the family been living in Canada? :
*
Q7 . Student's Health
Student's Allergies and/or Dietary Restrictions :
*
Student's Medications and Important Medical Information :
*
Q8 . Emergency Contact's Information
First and Last Name (Must be different from "Parent/guardian" info provided above) :
*
Relationship to Child :
*
Phone Number (cell or home) :
*
Q9 . Dismissal Information (please check one):
My child has permission to walk home alone.
My child will be picked up after each session by the following designated people:
Q10 . Person 1 (who can pick my child up)
Name :
Relationship to child :
Q11 . Person 2 (who can pick my child up)
Name :
Relationship to child :
Q12 . Person 3 (who can pick my child up)
Name :
Relationship to child :
Q13 . How did you hear about this program?
SFU website
Library website
Friend referral
SFU staff referral
City Centre Library referral
DIVERSEcity referral
Elementary or high school staff referral
Other
* My child has participated in this program before.
Q14 . If you selected "Other" above, please specify:
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Session Expires: 2024-04-25 11:44 AM