Winter in a Box 2026
Parent/Guardian Name:
*
First Name
Last Name
Email Address:
*
example@example.com
Phone Number:
Please enter a valid phone number.
Shipping Address for Supplies:
*
Street Address
Street Address Line 2
City
Province
Postal Code
Student Information
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 grade:
*
City/Town:
*
Province:
*
Please Select
New Brunswick
Newfoundland and Labrador
Nova Scotia
Prince Edward Island
EST / Itinerant Teacher Name:
First Name
Last Name
EST / Itinerant Teacher Email Address:
School Information
School District/Regional Centre for Education:
*
Please Select
First Nations School
NB - Anglophone North - Miramichi
NB - Anglophone South - Saint John
NB - Anglophone East - Moncton
NB - Anglophone West - Fredericton
NFLD - English School District
NS - Annapolis Valley Regional Education Centre
NS - Cape Breton-Victoria Regional Education Centre
NS - Chignecto-Central Regional Education Centre
NS - Conseil scolaire acadien provincial
NS - Halifax Regional Education Centre
NS - Mi’kmaw Kina’matnewey (MK)
NS - South Shore Regional Education Centre
NS - Strait Regional Education Centre
NS - Tri-County Regional Education Centre
PEI - First Nations School District
PEI - Public Schools Branch
School Name:
*
Additional Participants
How many other people will be attending (adults and children):
*
Please Select
0
1
2
3
4
5
1) Additional Participant
1) Participant Name:
First Name
Last Name
1) Relationship to Learner:
*
Please Select
Parent/Guardian
Sibling
1) Participant Age:
*
2) Additional Participant
2) Participant Name:
First Name
Last Name
2) Relationship to Learner:
*
Please Select
Parent/Guardian
Sibling
2) Participant Age:
*
3) Additional Participant
3) Participant Name:
First Name
Last Name
3) Relationship to Learner:
*
Please Select
Parent/Guardian
Sibling
3) Participant Age:
*
4) Additional Participant
4) Participant Name:
First Name
Last Name
4) Relationship to Learner:
*
Please Select
Parent/Guardian
Sibling
4) Participant Age:
*
5) Additional Participant
5) Participant Name:
First Name
Last Name
5) Relationship to Learner:
*
Please Select
Parent/Guardian
Sibling
5) Participant Age:
*
End of Form
Please select all days that you want to attend:
*
February 18, 2026
February 25, 2026
Feedback
How did you hear about this program?
*
Please Select
APSEA Website
Facebook
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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