2025 Fall Registration Form — Opal Family Services

Opal fall Registration 2025/2026

QUICK REGISTRATION FORM

Please fill out the quick registration form below if you are interested in signing up for our 2025/2026 Fall Respite Programs.

This form is designed to get the participant’s name in early and to let us know which program they are interested in attending. Please fill this out as soon as possible to reserve your spot.

*In order to attend our Fall programs, a second more detailed long form (linked below) must be completed to ensure we can provide a safe and enjoyable experience. Without submitting the second form, the participant CANNOT attend our programming. Please complete the long form within 48 hours of completing the initial registration form.

**If you have completed a Detailed Opal Information long form in the past year, you are not required to submit a second form unless there have been changes to their care needs.

Opal Family Services will contact you to confirm your registration upon receipt of all forms.

Contact Information

Individual's Name

First Name

Last Name

Date of Birth

MM

DD

YYYY

Parent/Guardian #1: Name

First Name

Last Name

Parent/Guardian #1: Phone Number

(###)

###

####

Parent/Guardian #1: Email

Social Worker's Name

Social Worker's Contact (Phone number AND email)

Fall Program Options

Please select the Fall program you are interested in below:

Kids Club (ages 5-12)

Teen Group

Adult Day Program (ages 18+)

If you are registering your child for Kids Club, please indicate the school they will attend this Fall below:

Transportation

Upon, request, transportation may be provided for the following programs: Adult Day Program and Kids Club. Please indicate below if you require transportation.

Subject to availability.

Yes

No

Payment

Upon agreement, Opal Family Services can provide monthly invoicing for the Fall Respite Programs. Please select the appropriate option below:

Social Development has agreed to receive monthly invoicing

Jordan's Principle has agreed to receive monthly invoicing

Parent/Guardian has agreed to receive monthly invoicing

Other

Payment can be made by e-transfer, sent to director@opalfamilyservices.ca, or a cheque. We will provide a receipt that can be submitted to Jordan’s Principle for reimbursement if applicable. It is the parent/guardian’s responsibility to confirm that Social Development or Jordan's Principle have agreed to provide funding or reimburse.

Link to Detailed Opal Information Long Form: https://forms.office.com/r/VZ0uwVmufG

Opal fall Registration 2025/2026

QUICK REGISTRATION FORM

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