Your E-mail Address
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Phone number
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City
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Province
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Postal Code
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Emergency Contact Information (optional)
Emergency Contact Name
Full Name
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Relationship to Participant
Relationship
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Emergency Contact Phone Number
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Health and Accessibility (mandatory)
Do you have any dietary restrictions or allergies?
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If yes, please specify
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Do you have any medical conditions or special needs we should be aware of?
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If yes, please specify
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Do you require any special accommodations for mobility or accessibility?
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If yes, please specify
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Program Details (optional)
Have you participated in a cybersecurity training program before?
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What are your primary goals for attending this training program?
(e.g., learning new skills, social interaction, personal development)
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Are there any specific topics or areas of interest you would like covered in the program?
(e.g., learning new skills, social interaction, personal development)
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Do you have access to a device (phone, laptop, tablet) which can be used to participate in exercises during the program?
(e.g., learning new skills, social interaction, personal development)
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Have you heard about online scams before?
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Which of the following online or digital scams are you familiar with? (select all that apply)
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Cohort Selection (mandatory)
Please specify which cohort place, date and time best works for you. Applicants will be documented based on the date selected and will be contacted and advised of the location.
Hamilton
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Brampton
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Transportation and Attendance (optional)
Will you require assistance with transportation to and from the program?
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If yes, please specify the nature of assistance required
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Consent and Agreement (mandatory)
Do you consent to having your photograph or video taken during the program for promotional or informational purposes?
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Do you agree to adhere to the program's policies and guidelines?
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How did you hear about this training program?
- - Select An Option -
Family/Friends
Social Media
Community Center
Other
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Other (please specify):
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Additional Information (optional)
Is there anything else you would like us to know or any questions you have about the program?
Please provide details
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Participant Signature
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Date
Select a date
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