Back To Youth Programs Country of Origin* Immigration Status*—Please choose an option—Permanent Resident (SINP)Permanent Resident (Family Class)Permanent Resident (Express Entry)Permanent Resident (Economic Immigrant)Refugee (GAR)CUAETRefugee(PSR) Program Choice*Pathways Spring Program (March-June) How did you hear about this program?*—Please choose an option—Social Media (Facebook, Instagram, LinkedIn, Twitter)Internet Search (Google, Bing, Yahoo)Referral Agency (NAARS, IWS, LARC)Community OrganizationSIA StaffFamily or FriendsMedia (News)Advertising (Poster or Brochure) Program Application Form Parent/Guardian Information First Name* Last Name* Relationship to the Applicant—Please choose an option—FatherMotherOther Home Address* Phone Number* Email Address* Permanent Resident Number or UCI * What is the best way to contact you?*—Please choose an option—PhoneEmailRegular Mail Have you attended any programs at SIA?—Please choose an option—LINCLITEMentorshipPACTB2EE4ENONE Are you able to transport your child?*—Please choose an option—Own VehiclePublic Transportation Parent/Guardian Consent I consent to the below child (or children) to participate in the Pathways program through the Saskatchewan Intercultural Association. I consent to the sharing of my child’s information with SIA program funders and I understand that my child’s information will not be shared with any unauthorized third party, and all information gathered will be kept confidential. Date Parent/ Guardian Signature* Applicant (Child’s) Information First Name* Last Name* Preferred Name Date of Birth* Gender*—Please choose an option—BoyGirlNon-Binary Age*—Please choose an option—6-89-1314-18 Date of Arrival in Canada* Immigration Status*—Please choose an option—Permanent Resident (SINP)Permanent Resident (Family Class)Permanent Resident (Express Entry)Permanent Resident (Economic Immigrant)Refugee (GAR)Refugee (PSR)CUAET Phone Number* Email Address* Permanent Resident Number or UCI * Country of Origin* What school does the applicant attend?* What grade is the applicant in?* Do you have any allergies or food restrictions (halal, vegetarian, etc...)?* Have you attended the Pathways program before? If yes, when?* What are some of your interests?* Add Child Applicant (Child’s) Information: Child 2 First Name* Last Name* Preferred Name Date of Birth* Gender*—Please choose an option—BoyGirlNon-BinaryPrefer Not to Say Age*—Please choose an option—6-89-1314-18 Date of Arrival in Canada* Immigration Status*—Please choose an option—Permanent Resident (SINP)Permanent Resident (Family Class)Permanent Resident (Express Entry)Permanent Resident (Economic Immigrant)Refugee (GAR)Refugee (PSR) Phone Number* Email Address* Permanent Resident Number or UCI* Country of Origin* What school does the applicant attend?* What grade is the applicant in?* Do you have any allergies or food restrictions (halal, vegetarian, etc...)?* Have you attended the ConnectED program before? If yes, when?* What are some of your interests?* Add Child Applicant (Child’s) Information: Child 3 First Name Last Name Preferred Name Date of Birth Gender—Please choose an option—BoyGirlOther Age—Please choose an option—6-89-1314-18 Date of Arrival in Canada Immigration Status—Please choose an option—Permanent Resident (SINP)Permanent Resident (Family Class)Permanent Resident (Express Entry)Permanent Resident (Economic Immigrant)Refugee (GAR)Refugee (PSR) Phone Number Email Address Permanent Resident Number or UCI CUAET No. * Country of Origin* What school does the applicant attend?* What grade is the applicant in?* Do you have any allergies or food restrictions (halal, vegetarian, etc...)? Have you attended the ConnectED program before? If yes, when? What are some of your interests? Add Child Applicant (Child’s) Information: Child 4 First Name Last Name Preferred Name Date of Birth Gender—Please choose an option—BoyGirlOther Age—Please choose an option—6-89-1314-18 Date of Arrival in Canada Immigration Status—Please choose an option—Permanent Resident (SINP)Permanent Resident (Family Class)Permanent Resident (Express Entry)Permanent Resident (Economic Immigrant)Refugee (GAR)Refugee (PSR) Phone Number Email Address Permanent Resident Number or UCI Country of Origin* What school does the applicant attend?* What grade is the applicant in?* Do you have any allergies or food restrictions (halal, vegetarian, etc...)? Have you attended the ConnectED program before? If yes, when? What are some of your interests? Add Child Applicant (Child’s) Information: Child 5 First Name Last Name Preferred Name Date of Birth Gender—Please choose an option—BoyGirlOther Age—Please choose an option—6-89-1314-18 Date of Arrival in Canada Immigration Status—Please choose an option—Permanent Resident (SINP)Permanent Resident (Family Class)Permanent Resident (Express Entry)Permanent Resident (Economic Immigrant)Refugee (GAR)Refugee (PSR) Phone Number Email Address Permanent Resident Number or UCI CUAET No. * Country of Origin* What school does the applicant attend?* What grade is the applicant in?* Do you have any allergies or food restrictions (halal, vegetarian, etc...)? Have you attended the ConnectED program before? If yes, when? What are some of your interests? Information Release Waiver: Consent to sharing personal information within SIA I consent to the Saskatchewan Intercultural Association to obtain, use, and release my personal information to any person or agency as may be necessary to support my learning and/or establish eligibility for my participation within other Saskatchewan Intercultural Association programs. YesNo Media Release Waiver: Consent to collect, use, and release pictures or comments I give consent to the Saskatchewan Intercultural Association (SIA) to use photographs taken of myself and to use my recorded comments in the Saskatchewan Intercultural Association's newsletter, on the agency's website and Facebook page, and in other promotional materials such as PowerPoint presentations, brochures, and displays. These photographs and comments will be for the sole use of the Saskatchewan Intercultural Association and will not appear with your name unless requested.YesNo Travel Liability and Assumption of Responsibility Waiver Assumption of Risks: I understand that as a participant of Saskatchewan Intercultural Association’s Youth program, our class will occasionally go on field trips to various locations. As such, I recognize that I may be exposed to risks to my person during periods of transportation or at offsite premises while participating in field trip activities. I freely and voluntarily accept and assume all risks, dangers and hazards. Accordingly, I understand that despite its efforts, the Saskatchewan Intercultural Association may not be able to ensure my complete safety at all times. Assumption of Responsibility: I understand that it is my responsibility to abide by all applicable Saskatchewan Intercultural Association policies and the policies of the host location. More particularly, I understand that the Saskatchewan Intercultural Association does not carry accident or injury insurance for my benefit and also that there may be certain matters for which I could be held at fault personally if my activities or conduct fall short of what would be considered a reasonable standard for an individual. In these cases, I agree to be accountable in all respects for my own actions and not to ask the Saskatchewan Intercultural Association or its employees to accept the consequences thereof; further, I agree to be responsible for any claims made against the Saskatchewan Intercultural Association in relation to such actions. I acknowledge that I have been advised by the Saskatchewan Intercultural Association of such risks and dangers as well as the need to act in a responsible manner at all times. My signature below is given freely in order to indicate my understanding of the acceptance of these realities and in consideration for being permitted by the Saskatchewan Intercultural Association to participate in the above-mentioned program. By signing this legal document, you give up certain legal rights, including the right to sue.YesNo Email Release Waiver: Consent to electronic communications I give consent to the Saskatchewan Intercultural Association to use my email address to contact me about SIA-related programs, services, and events. Examples of communications would be program information, registration deadlines, upcoming events and classes, and SIA news. I understand that I can opt-out and unsubscribe at any time. YesNo Subscribe to receive email communications from SIA about programs, events and announcementsYesNo Δ Sign up for our newsletter click here