FASD - Program Registration

We are excited that you have decided to join us at Whitecrow Village!  If you have already been notified of your secure username and password, please proceed to STEP TWO (below).

STEP ONE

To assist us in reserving a place for you or your group in your chosen Whitecrow Village session or program, please complete the brief questionnaire below.  We will do our best to accommodate your specific requests; however, due to a growing number of interested applicants and often limited spaces in our unique programs, we cannot guarantee available space in your preferred session(s) at this time. 

Once we have reviewed your request, we will respond via email with:

1. A confirmation of dates and sessions with available space for you or your group
2. A secure username and password for you to proceed to our online registration system. 

**Please Note:  (Without exception) Whitecrow Village program participants and volunteers younger than 19 years of age must be accompanied by an adult caregiver or legal guardian.

* Indicates a required field

First Name*

Surname*

Email*

Phone*

Program & Session Dates Requested*

PLEASE ADD ME TO THE WAIT LIST
I AM INTERESTED IN VOLUNTEERING

May 13-May 14, 2011  COMMUNITY TRAINING (PART A) (Victoria, BC) Full
May 27-May 28, 2011  COMMUNITY TRAINING (PART B) (Victoria, BC) Full
Jun 12-Jun 16, 2011  COMMUNITY TRAINING (Atlin, BC) Full
Jul 10-Jul 16, 2011  L.I.F.E. SESSION (Lake Cowichan, BC) Full
Jul 30-Aug 1, 2011  WORKSHOP (Denman Island)
Aug 8-Aug 13, 2011  L.I.F.E. SESSION (Lake Cowichan, BC)
Aug 24-Sep 4, 2011  L.I.F.E. SESSION (Atlantic Canada)
Jul 8-Jul 14, 2012  L.I.F.E. SESSION (Denman Island)
Jul 15-Jul 22, 2012  L.I.F.E. SESSION (Denman Island)
Aug 23-Aug 29, 2012  L.I.F.E. SESSION (Denman Island)

Number of People Attending*

0 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20

Number of Adults (19+ years)*

0 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20

Number of Children*

0 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20

Have you or anyone in your group previously attended a Whitecrow Village session? If so, what program, when, and where?*

Please provide a brief description of yourself/ your group (i.e. family, professionals, children's ages, etc.) *

Is there anything else you would like us to know at this time?

Please type in the code you see on the left*

STEP TWO

If you have already been notified of your username and password, please continue to our online registration system below: