Curriculum Café

Registration Form

Join us each month for our Family Councils Curriculum Café! Our Cafés are designed specifically for family council members and home staff who are wanting to deepen their understanding of, and work within their long-term care community.

Each month we will explore a new theme and registrants will be provided with resources to review, live training and active engagement opportunities, as well as the opportunity to network with other council members across the province.

Complete this registration form to sign up for the café series. Please contact Sam Peck speck@fco.ngo if you have any questions.

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* 1. What is your full name?

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* 2. What is your email address?

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* 3. What is the name of the long-term care home you are responding from?

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* 4. How are you connected to this long-term care home?

I am the long-term care home administrator

I am a member of the home's current family council

I was a member of the home's previous family council

Other (please specify)

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* 5. Does this long-term care home currently have an active family council?

Yes

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* 6. What are the top three issues your long-term care home / family council are facing?

Recruitment

Hosting effective meetings

Peer support

Group dynamics

Conflict resolution

Collaboration with home staff

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* 7. In order to help us plan our live sessions, please indicate the dates/times that you are available to participate:

	Mondays	Tuesdays	Wednesdays	Thursdays	Fridays
Mornings	Mornings Mondays	Mornings Tuesdays	Mornings Wednesdays	Mornings Thursdays	Mornings Fridays
Afternoons	Afternoons Mondays	Afternoons Tuesdays	Afternoons Wednesdays	Afternoons Thursdays	Afternoons Fridays
Evenings	Evenings Mondays	Evenings Tuesdays	Evenings Wednesdays	Evenings Thursdays	Evenings Fridays

Other (please specify)