Grand Bend Train Your Brain - Literacy Lambton

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180 N. College Ave Room 103
Sarnia, Ontario
N7T 7X2

Phone: (519) 332-4876

Registered Charity: #135262012RR0001

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Grand Bend Train Your Brain Registration

Tuesday Nights
Oct 6 – Nov 24, 2026
6-7:30pm

Grand Bend Legion
20 Municipal Dr., Grand Bend

Does you child require any elements to feel supported in our program? If so, please contact Tracy Pound, 519-332-4876 or admin@literacylambton.org to discuss further.

Name

This field is for validation purposes and should be left unchanged.

Parent Name(Required)

First Last

Email(Required)

Enter Email Confirm Email

Main Phone Number:(Required)

Alternate Phone Number:

Please provide the name and grade of the child you are registering.

NOTE: This program is only for kids currently enrolled in grade 3 or 4. If you are registering multiple children, you will need to submit a form for each child.

Child's Name:(Required)

First Last

Please select grade:(Required)

How did you learn about the Literacy Lambton Programs or how did you find out about this course? Please check all that apply.(Required)

Social Media

Newspaper

Word of Mouth

Poster/Community Board

Program and Activity Guide

Coffee News

Email

Radio

Agency Referral

Other

Agency Referral or Other? Please share where:

Are there any learning challenges you want us to be aware of?(Required)

No

Yes

If yes, what is your challenge?

Voluntary Disclosure: Are there any pre-existing medical issues we need to be made aware of?(Required)

No

Yes

Pre-Existing Medical Condition/Medication:

Emergency Contact #1 - Name, Relationship and Phone Number(s)

Emergency Contact #2 - Name, Relationship and Phone Number(s)

Throughout the year we like to promote our programs to the media, on our website, social media sites, newsletters and bulletin boards. In order to video tape, photograph or interview our participants we need your permission to publish to these public sources. Under the Freedom of Information and Protection of Privacy Act (FOIP) Literacy Lambton requires the consent to use your information outlined as above.

Please complete the information below with a check mark to indicate your choice:(Required)

Yes, I give my consent for the publication of my name/my childs name, image or comments to be used for the purpose described above.

No, I do not give my consent for the publication of my name/my child's name, image or comments to be used for the purpose described above.

Consent to Release Information(Required)

In order to facilitate our programs we are required to share information with our instructors.

I give permission for Literacy Lambton to share the personal information that I have provided, along with information about my learning, with my instructor.

Date

Our Programs

Adult Literacy Program

Family Literacy Program

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