CARMIS Smart Forms - Bilal Community and Family Centre

BCFC Summer Youth Program Registration Form 2025

Your Personal Details

First Name(Required)

Middle Name

Last Name(Required)

Status in Canada(Required)

Permanent Resident or UCI#(Required)

Permanent Resident or UCI#

Date of Birth as per PR Card(Required)

Gender(Required)

Email Address(Required)

Cell Phone

Home Phone

Work Phone Number

Native Language(Required)

Other Spoken Languages (if applicable)

Are you currently attending school?

Yes

if yes which school:(Required)

Do you have any health concerns that BCFC staff should be aware of such as: allergies, asthma and etc?

Yes

Please list the allergies, asthma or other medical conditions:(Required)

Current Residential Address

Address(Required)

City

Province(Required)

Postal Code(Required)

Emergency Contact Information

Full Name(Required)

Phone Number(Required)

Email(Required)

Photo Consent:

Please Sign below to grant permission for Bilal Summer Youth Program 2025 and Aurora Family Therapy Centre Inc. the reasonable use of pictures containing your child in any or all the following ways: funding reports, promotional materials, websites, and/or social media.

Client's Signature(Required)

Full name OR Sign in previous box

Date(Required)

If under 18:

Guardian Signature

Guardian’s Full Name

Date

Captcha