Digital Computer Literacy Sign up Form About YouYour Name(Required) First Last Your Address Street Address Address Line 2 City Province AlbertaBritish ColumbiaManitobaNew BrunswickNewfoundland and LabradorNorthwest TerritoriesNova ScotiaNunavutOntarioPrince Edward IslandQuebecSaskatchewanYukon Postal Code How Can We Reach You?We would love to chat with you. How can we get in touch?Preferred Method of ContactEmailPhoneYour Email Address(Required) Email Address Confirm Email Address Your Phone(Required)Best Time to Call YouSelect A Time12:00 am12:30 am1:00 am1:30 am2:00 am2:30 am3:00 am3:30 am4:00 am4:30 am5:00 am5:30 am6:00 am6:30 am7:00 am7:30 am8:00 am8:30 am9:00 am9:30 am10:00 am10:30 am11:00 am11:30 am12:00 pm12:30 pm1:00 pm1:30 pm2:00 pm2:30 pm3:00 pm3:30 pm4:00 pm4:30 pm5:00 pm5:30 pm6:00 pm6:30 pm7:00 pm7:30 pm8:00 pm8:30 pm9:00 pm9:30 pm10:00 pm10:30 pm11:00 pm11:30 pmWhich city are you from?(Required)BramptonMississaugaCaledonTorontoVaughanOtherIf your response is Other, Please specify Age(Required)14-1821-2525-3030+Are you currently in school? Please choose your current education level(Required)Middle SchoolHigh SchoolCollegeUniversityN/AOtherIf your response is other, Please specify If you are a member of a racial or ethnic minority group, please select which group. Note that you can select multiple options(Required) Black East Asian Indigenous/Metis Latino Middle Eastern South Asian South East Asian West Asian Indo-Caribbean White Decline to answer Other Select AllIf your response is other, please specify Source of Income Ontario Works ODSP Employed Self Employed Unemployed Select AllIncome Bracket(Required) less than $14,580 $14,580 - $30,000 $31,000 + Convenient Day and time to attend session(Required) Virtual: Tuesdays (4:30 PM - 6 PM) In-Person: Thursdays (11 AM - 1 PM) Are there any particular topics related to digital literacy that you are interested in learning about?Do you consent to your pictures being used on promotional materials such as our pamphlets, brochures, and social media? Note: If you are under 18 years of age please ask your parent/guardian to complete this question along with the others in the next section Yes No I am under 18 years of age Other Parental Consent SectionPlease ask your parent/guardian to complete the following section if you are under 18 years of age.Parent/Guardian Name (first and last) First Last Parent/Guardian Email Parent/Guardian Phone NumberDo your (parent/guardian) consent to your youth attending the Youth Digital Literacy program hosted by CASE Community Services? Yes No Other Do your (parent/guardian) consent to CASE Community Services sending emails to your youth for sharing information about programs and upcoming events? Yes No Other Do your (parent/guardian) consent to pictures of your youth being used on promotional materials such as our pamphlets, brochures and social media? Yes No Other What's on your mind?Please let us know what's on your mind. Have a question for us? Ask away.Your Comments/Questions