Breaking Bread & Building Community - Aurora Black Community

Breaking Bread & Building Community Registration

This is a cultural food tasting experience celebrating Black culture.

Name

First

Last

You Name purposes

Phone Number

Parent or Guardian Name (required for all programs involving minors)

First

Last

Transportation or Ride Needed? (ABC may provide transportation support)

Do You Have Accessibility Needs or Accommodations?

If Yes Please List Here:

Number of guests attending

Selected Value: 1

City of Residence

Emergency Contact Name

First

Last

Emergency Contact Phone Number

How Did You Hear About Us?

Checkboxes

Do you consent to photo and media release allowing ABC to use images or video for promotional purposes

Parental/Guardian Consent

Privacy Statement

The information collected will be used solely for program administration, communication, and delivery purposes. Information may be shared with third-party partners or service providers where necessary for participation in or operation of ABC programs and services (including program venues, activity providers, transportation providers, or partner organizations), in accordance with applicable Canadian privacy legislation.