Tween Takeover Enrollment

Thank you for your interest in attending the *NEW* Tween Takeover at the Shared Spaces, supported by the Adult Ally team from Big Brothers Big Sisters of the Battlefords and Battle River Treaty 6 Health Centre | Battlefords Family Health Centre). Enrollment for this session is limited to 8-10 participants. An email will be sent to confirm enrollment along with the required consent forms.

Below we ask basic information to enroll your youth and ensure we are able to support any needs they have to fully participate in the program.

We also ask for some thoughts and insight into what they are hoping to experience from their time at the Shared Spaces and if there are ways you feel we can help them with the #CircleOfSupport mentoring we offer through programming and the Adult Ally team.

At the end it will ask for your consent to have that basic information shared with us. An additional consent and media release form will be emailed to you via Adobe Sign to complete following your enrollment confirmation. A link to the consent form is included at the bottom of the form for you to take a peek at prior to submitting your enrollment info. If you have additional questions or would prefer to chat more with us, there is a space to let us know that and we are happy to answer any questions you might have about the program.

We look forward to having your youth join us! 🙂

Dates Currently Scheduled:

Tues, Sept 23rd | 5:30 – 7pm – Welcome and Bead Animal Keychains

Tues, Oct 28th | 5:30 – 7pm – Halloween Fun

Tues, Nov 25th | 5:30 – 7pm – TBD

Tues, Dec 16th | 5:30 – 7pm – Christmas and Holiday Festivities

Youth Info
Name*
First Last
Preferred Name:
How does your youth identify (male, female, transgender, two-spirited, etc.):
What pronouns do they prefer [Ex: she/her | he/him | they/them]:
Birthdate:*
MM slash DD slash YYYY
School Attending:*
School (if not listed above):
Grade:*
Home Address:*
Do you (the youth) have any food allergies we need to be aware of?:*
What interests you (the youth) the most about Tween Takeover or other programming at the Shared Spaces? Is there anything you hope to experience or do?
Parent | Guardian | Supportive Adult Info
Name*
First Last
Contact Number:*
Contact Email:*
Relationship to the Youth (ie: Mom, Dad, Grandparent, etc):*
Are you the emergency contact you want listed?*
- Yes I am
- No, I am listing someone else below
Other Emergency Contact (Name, Contact Number, Relationship to the Youth):
How do you think your youth will benefit from Tween Takeover or the programming offered at the Shared Spaces? Is there something specific you feel we can help them with?*
Please share any medical or mental health conditions that may impact your youth's participation or that the Adult Ally team should be aware of?:*
Would you like to be added to our contact list to stay in the know for future youth events, activities, and opportunities?
- Definitely!
- No thanks!
I agree to consent to my youth attending Tween Takeover and other programming offered at the Shared Spaces. I agree to complete tthe consent form that will be sent to me via Adobe Sign prior to my youth attending.*
- Yes
- No
- I would like to chat further with the Program Lead and sign in-person
For more information and details please click the link highlighted below.
Parent/Guardian Signature*
Date*
MM slash DD slash YYYY
CAPTCHA
Name
This field is for validation purposes and should be left unchanged.

Informed Consent and Media Release

[Click for Forms]

[Must be completed prior to via Adobe Sign OR handed in at drop off at the 1st program]

Tween Takeover Enrollment

Youth Info

Parent | Guardian | Supportive Adult Info

Informed Consent and Media Release

[Click for Forms]