Skills Training Centre Registration Form

Course Name
Course Start Date
MM slash DD slash YYYY
Course End Date
MM slash DD slash YYYY
First Name
Last Name
Name as it should appear on Certificate of Completion
Address
City
Province
Postal Code
Phone
Email
Date of Birth*
MM slash DD slash YYYY
Age Range
Your First Language
Your Country of Origin*
Level of English Language Proficiency
Status in Canada*
Consent
I agree and accept that all information provided on this form is true and complete.
I understand that the information used on this form may be used for statistical purposes.
By checking this box and typing my name below, I am electronically signing this registration form.
Full Name
By checking this box, I hereby grant permission to DIVERSEcity Community Resources Society the right to use my photograph, video image and sound, testimonials, quotations and/or story for use in DIVERSEcity communications material. This material includes social media content, website content, brochures, flyers and other print and video media for public consumption, as well as in release to print and digital media for their use. I have been informed that my participation is entirely voluntary. I hereby waive the right to receive any payment for use of any of the material described above, and discharge the Society of any liability on the use of the information and/or material provided. I have read and understood the information in this release form to the best of my ability.
Release Form
By checking this box, I hereby grant permission to DIVERSEcity Community Resources Society the right to use my photograph, video image and sound, testimonials, quotations and/or story for use in DIVERSEcity communications material. This material includes social media content, website content, brochures, flyers and other print and video media for public consumption, as well as in release to print and digital media for their use. I have been informed that my participation is entirely voluntary. I hereby waive the right to receive any payment for use of any of the material described above, and discharge the Society of any liability on the use of the information and/or material provided. I have read and understood the information in this release form to the best of my ability.