CyberSecure Registration/Wait List Form * Indicates a required field. First Name:* Last Name:* Phone Number:* (123-123-1234) Email Address:* Gender:* MaleFemaleNon-BinaryPrefer not to say Age:* 12-1855+ Ethnicity:* Black (African, African-Canadian, Afro-Caribbean, Afro-Latin)Indigenous (First Nation, Inuit, Métis, non-status)South/East Asian (examples: Filipino, Chinese, Japanese, Korean, Malaysian, Singaporean, Thai, Vietnamese)Latin American (examples: Brazilian, Colombian, Cuban, Mexican, Peruvian)White (English, Greek, Italian, Portuguese, Russian, Slovakian)South Asian or Indo-Caribbean (examples: Indian, Indo-Guyanese, Indo-Trinidadian, Pakistani, Sri Lankan)OtherPrefer not to say Program Participant/Parent Consent Declaration Please confirm below whether you agree or do not agree to the following: Activity Permission: I hereby consent and grant permission for myself/my child to participate in all program activities, unless I advise you otherwise, in advance, in writing. AgreeDo not agree Declaration: I understand that my place is not saved until I have received confirmation from Tropicana.* How did you hear about this event?* EmailFacebookInstagramLinkedInOther Do you want to sign up to receive emails from Tropicana?* I would like to receive communications from Tropicana Community Services. I understand that I can unsubscribe at any time.I do not wish to receive any communications from Tropicana Community Services Δ
