JA Company Program Revelstoke

Dates: November 26, 2026 – February 25, 2027 (with holiday and other breaks)
Times: Thursdays, 4:30–6:30 PM
Location: Community Futures Revelstoke | 301 Victoria Road, Revelstoke, BC
Registration Deadline: November 12, 2026
Capacity: 15 students
Free of charge

To complete your registration, please:
1. Complete the parent/guardian information and consent section
2. Complete the student information and consent section

Thank you!

1. Parent/Guardian Information and Consent

*Parent/guardian first name:

*Parent/guardian last name:

*Parent/guardian email address:

*Parent/guardian phone number:
(ex: 999-999-9999)

*Your child's first name:

*Your child's last name:

*By checking below I confirm have read and agree to Participant Responsibilities and give permission for my child to participate in the JABC After-School Program at the location listed above. I give permission for JABC to use the information in this document to contact my child asappropriate for relevant information and communications.

*Parent/guardian name:

*By checking below I confirm I am aware that photographs or video footage of mychild may be used by the media for broadcast or in printed publications, included indisplays and/or electronic media, and/or printed in publications to raise awareness ofJA programs and activities. I understand that JA and JA sponsors will not use anyimages in a manner that may be deemed adverse or defamatory. I do not hold JA responsible for informal photos taken by other students participating in theprogram. This agreement may be cancelled at any time at the discretion of either party

*By submitting this survey/registration, I acknowledge that the personal information requested is collected under the authority of section 26(c) of the Freedom of Information and Protection of Privacy Act (FOIPPA) and will be used by Columbia Basin Trust (the Trust) for event registration and evaluation purposes. Please be aware that personal information will be stored and processed by SimpleSurvey on servers located within Canada. The collection, use, and disclosure of personal information are subject to the provisions of FOIPPA. For questions regarding the handling of your personal information, you may contact the Privacy Officer at Columbia Basin Trust, Suite 300, 445–13 Ave., Castlegar, BC, V1N 1G1, via email at privacy@ourtrust.org or by phone at 1.800.505.8998. By providing your personal information, you consent to its collection, storage, and processing as described above.