Registration LDA Child and Youth Registration "*" indicates required fields Parent/Caregiver 1* First Last Parent/Caregiver 2 First Last Parent/Caregiver Daytime Phone*Parent/Caregiver Email* Child/Youth Name* First Last Date of birth (DDMMYYYY)* MM slash DD slash YYYY What grade is the child/youth in?*Address Street Address Address Line 2 City AlbertaBritish ColumbiaManitobaNew BrunswickNewfoundland and LabradorNorthwest TerritoriesNova ScotiaNunavutOntarioPrince Edward IslandQuebecSaskatchewanYukon Province Postal Code Which session(s) are you registering for?*Academic Skills ProgramReading & WritingB.C. Wide Online Reading ProgramEmotional Social DevelopmentHas the applicant been assessed or diagnosed with any of the following?* LD AD(H)D Anxiety Disorder Other None If you selected "Other" for the above question, please specify what the applicant has been assessed/diagnosed with:Do you have any concern about your child/youth's learning or behaviour development?* Yes No If so, please describe your concernsPlease provide any additional information you would like us to know about your child/youth (preferred pronouns, interests, strengths, etc.).If available, do you require financial assistance?* Yes No Would you prefer in-person or virtual (if available)* In-person Virtual CAPTCHAPhoneThis field is for validation purposes and should be left unchanged.
