Youth Membership Form 2020

First Name *

Last Name *

Address *

Address 2

City *

State/Province *

Zip/Postal Code *

Phone *

Email Address *

Date of birth * +

Age *

Preferred way to contact *

Phone

Email

Any

School *

Grade *

Allergies/health concerns *

Emergency Contact

First Name *

Last Name *

Relationship to you *

Phone Number *

Email Address *

Eastview Programs involved in 2020/2021

Select Programs involved in this year: *

Volunteer Experience

How many volunteer hours (estimate) have you completed to date?: *

Volunteer activities to date:

Would you like to volunteer at Eastview? *

Yes

No

If yes, what programs would you like to get involved with?

Demographic Information

I identify as: *

My preferred pronouns are: *

he/him

she/her

they/them

Not listed, please describe: Not listed, please describe:

Ethnicity(ies): *

Black (ex. African, Caribbean, African-Canadian)

East Asian (ex. Chinese, Japanese, Korean)

Latino or Hispanic (ex. Colombian, Cuban, Mexican, Peruvian)

Middle Eastern (ex. Afghan, Iranian, Lebanese, Saudi Arabian, Syrian)

South Asian (ex. Bangladeshi, Indian, Pakistani, Sri Lankan)

Southeast Asian (ex. Filipino, Malaysian, Singaporean, Thai, Vietnamese)

Caucasian (ex. English, Greek, Italian, Portuguese, Russian, Slovakian)

First Nations or Indigenous

Not listed, please describe: Not listed, please describe:

Language(s) spoken at home: *

First language that you learned to speak *

Are you a Newcomer to Canada? *Newcomer: came to Canada within the last 5 years *

Yes

No

Did your parents immigrate to Canada? *

Yes

No

If yes, from where: If yes, from where:

Do you require any accommodations (physical, mental, communication, etc)? *

Terms and Conditions *

You consent to receive communications from us electronically. We will communicate with you by e-mail or phone. You agree that all agreements, notices, disclosures and other communications that we provide to you electronically satisfy any legal requirement that such communications be in writing.

Please sign *

clear