CHOICES – Registration Form

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CHOICES is a free social skills program for young people aged 12-17 that supports youth to find the right direction in life. This program will encourage youth to think and act positively, feel more confident and learn healthy coping strategies with other young people. Group sessions are held every week for 10 weeks and are led by community role models.  Evening and daytime sessions are available.

At CHOICES, youth will talk and explore topics including:

  • Communication
  • Decision Making
  • Communication
  • Goal Setting
  • Alcohol
  • Coping Skills
  • Relationships
  • Prescription Drugs
  • Self-Respect
  • Risk Taking/Social Media
  • Graduation

CHOICES is offered by Uturn, a partnership with Thunder Bay Counselling, Children’s Centre Thunder Bay and St. Joseph’s Care Group.  We are currently seeking volunteers to be involved as role models.  For more information, about this opportunity, view our information flyer and volunteer flyer. To become a volunteer with CHOICES, visit our Volunteer page.

Contact Pia at 684-1871 for more information.

Youth Information

Youth Name:*

Youth Gender:*

Youth Date of Birth:*
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Youth Address:*
Youth Phone:*

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Youth Cell:

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Youth Contact OK?*
Youth Message OK?*

Referent Information

(person completing the registration)

Referent Name:*

Relationship to Youth:*

Agency:

Referent Address:
Referent Phone:*

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Referent Email:*
Referent Fax:

Referant Contact OK?*

Referral Reasons

Check all that apply:*

Family Information

Parent/Guardian Involvement:*
If Yes,
Permission to Contact:
Parent/Guardian 1 Name:

Parent/Guardian 1 Phone:

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Parent/Guardian 2 Name:

Parent/Guardian 2 Phone:

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Parent/Guardian 3 Name:

Parent/Guardian 3 Phone:

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Youth Information

Attending School:*
If yes, Grade:

If yes, Where:

Please indicate any agencies or services the youth is currently involved with:*
Additional Comments: