CICS

Program Registration

Location:

Login:

Or just fill in the form below:

Personal Information

*First Name

*Last Name

*Age

*Gender

* Date of Birth (YYYY-MM-DD):

Please fill in at least one of the two phone number input boxes

*Phone:

*Mobile:

*Email

*Address

*Postal Code

*City

*Province

Settlement Information

Your first time registering for CICS activities?

* Years in Canada:

Immigration Status and Information

Immigration Status

Country of Origin:

Children under 18

*No. of Children:

Disclaimer

By signing this authorization you are agreeing to the following statements ( Please note that CICS stands for Centre for Immigrant and Community Services) * Participants should take care of their own safety. The agency is not liable for any personal loss or damage.

For refund conditions, please make reference to our agency’s refund policy.

CONSENT (V)
I hereby give CICS the right to obtain media recording including but not limited to photographs and videos of myself for promotional and any other uses by CICS through its media outlets.

I hereby give permissions to CICS to deliver agency information to my email address.

For parent/guardian of applicants under 18 only:
* I hereby give permission for my child to participate in the above activity and to receive emergency treatment if necessary and release CICS from all claims arising from any accident, loss or injuries which are caused by or arising from such participation and/or treatment.

* Security Number:

Type the numbers you see in the block