Spring in a Box
2025
Student Name:
*
First Name
Last Name
Student Grade:
*
Please Select
Primary
1
2
3
4
5
6
7
8
9
10
11
12
Other
If Other, please specify:
*
Parent/Guardian Information
Full Name:
*
First Name
Last Name
Email Address:
*
example@example.com
Are you over the age of 19?
*
Yes
Your Role:
*
Please Select
Parent/Caregiver/Family Member
APSEA Staff
Education Staff
Community Partner
Other
If Other, please specify:
*
Would you like to receive notifications about new programs and opportunities directly from us? Your information will not be shared.
Yes, add my email address to your mailing list.
Program Details
Please select all the dates the Learner will be participating in:
*
Thursday, April 3, 2025
Thursday, April 10, 2025
Thursday, April 17, 2025
Thursday, April 24, 2025
Shipping address for supplies to be sent to:
*
Street Address
Street Address Line 2
City
Province
Postal Code
Accommodation Requirements:
ASL/English Interpretation
Other
Additional Participants
Siblings are welcome to participate, too! Please be sure to let us know if siblings will be joining.
Will siblings be participating?
*
Yes
No
Additional Participant 1
1) Additional Participant Name:
First Name
Last Name
1) Age:
1) Relationship to Learner:
Additional Participant 2
2) Additional Participant Name:
First Name
Last Name
2) Age:
2) Relationship to Learner:
Additional Participant 3
3) Additional Participant Name:
First Name
Last Name
3) Age:
3) Relationship to Learner:
End
Feedback
How did you hear about this program?
*
Please Select
APSEA Website
Facebook
X (Twitter)
APSEA Email
APSEA Event Postcard
APSEA Service Delivery Team Meeting
APSEA Specialist
Word of Mouth
Other
If Other for how you found out about this program, please specify
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