Strengthening Families Referral Form Referral Form Step 1 of 2 50% DisclaimerStrengthening Families Saskatoon (SFS) is a family-based skills training program to support children and youth who are showing behaviors that put them at risk of criminality and gang activity. Confirm Question(s) When you begin filling out the Program Referral Form, you will first be asked to provide information about yourself. Then you will be asked to provide information about the child/youth you are registering (the “Registrant”) and the Registrant’s parent(s)/legal guardian(s). By proceeding to refer a Registrant, you are confirming to have the consent of the Registrant’s parent(s)/legal guardian(s) to provide SFS with the required information. Before registering you must carefully read the terms of use below. By filling out the Program Referral Form you agree that you have read, understood and agree to be bound by these terms of use. Through this form, SFS will collect information that can identify you, the Registrant and/or the parent/legal guardian of the Registrant. This information may include, but is not limited to, the Registrant’s name, and date of birth, and their parent’s/legal guardian’s e-mail address, mailing address and other similar information ("Personal Data"). The SFS will use the Personal Data to contact and meet with the Registrant’s parent(s)/legal guardian(s) to discuss the Registrant’s participation in the program. From time to time, SFS may refer to the Personal Data to better understand you or the Registrant's needs and how we can improve our services in relation to you, the Registrant’s parent(s)/legal guardian(s) and/or the Registrant. The retention, as well as any other use or disclosure of the Personal Data, will be as authorized by The Local Authority Freedom of Information and Protection of Privacy Act, SS 1990-91, c L-27.1. You agree to the use of the provided Personal Data by the SFS for the above stated purposes. You release, waive and forever discharge SFS, the Saskatoon Board of Police Commissioners and the Saskatoon Police Service and its employees, agents and assigns from all claims, demands, damages, costs, expenses, actions, causes of actions, whether in law or equity, resulting or alleged to directly or indirectly result from you, the Registrant, or any other parties' use or involvement in the SFS online referral process. You are also confirming to have the authority to provide SFS with the Personal Data provided and consent to its collection, use, and disclosure, as you are: One of the following must be applicable:* A member of a Referral Agency who has obtained informed consent from the Registrant’s parent/legal guardian; The parent/legal guardian of the Registrant; or The Registrant, over the age of 16, and can speak on your own behalf. By proceeding to refer a Registrant using the SFS online program referral form, you agree to be bound by the above terms. Program Referral FormStrengthening Families Saskatoon is a proven family-based skills training program. The program goals are to improve parenting, communication, and social skills within the family unit. The benefits in completing this 14-week program are to: Improve parenting skills Improve family communication skills Improve family problem solving skills Improve school attendance and performance Improve the family's ability to work together Improve Social Skills Improve family attachment and bonding Reduce violent or aggressive behaviours Resist the temptation of negative influences Decrease the use drugs, alcohol and tobacco Important Note for Referring Agencies: By making this referral, you are acknowledging that you have spoken to the parent/caregiver about Strengthening Families Saskatoon (SFS) and they have given informed consent for the SFS staff to meet with them to discuss their participation in the program. Referring Agency*Saskatoon Police ServiceChild and Family Program - Ministry of Social ServicesSaskatoon Health RegionSaskatoon Public SchoolsGreater Catholic SchoolsThe City of SaskatoonOtherParent/Caregiver*Consent* Yes No Date of Referral* Referring Agency InfoNameAddressPhoneEmail Parent/Caregiver InfoName*Date of Birth Address*Phone*Child/Youth Name*Birthdate* Sex* Male Female Child/Youth Contact Information*Describe your role or relationship with this child/youth?*Which risk factors are relevant to the referral of this child/youth to Strengthening Families Saskatoon? alcohol physical violence victim parenting concerns drugs physical violence perpetrator housing gambling emotional violence victim sexual orientation mental health emotional violence perpetrator negative peers cognitive impairment sexual violence victim anti-social behaviour physical health sexual violence perpetrator suicide unemployment elderly abuse perpetrator missing-runaway self-harm poor supervision threat to public safety criminal involvement basic needs gangs crime victimization missing school social environment grief/loss rapid cultural transformation lack of transportation What other concerns do you have regarding this child/youth?*What other agencies or services have been, or are currently being provided to this child/youth?* Strengthening Families Saskatoon Making Saskatoon STRONGER One Family at a Time. © 2017 FOLLOW US FollowFollowFollowFollow