Child Date of Birth
(required)
Parent First Name
(required)
Parent Last Name
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Municipality
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Burlington
Halton Hills
Milton
Oakville
Postal code
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Phone number
(required)
Email address
(required)
Confirm Email address
(required)
Do you have a disability-related accommodation need? If yes, please specify
If you have provided your e-mail address, Halton Region will use it to communicate with you about the programs you have registered for. If you have registered for the Halton Breastfeeding Connection, we are also seeking your permission to provide your email address to your Breastfeeding Connection volunteer. If you consent, your volunteer will email you and follow up with a telephone call. You should note that there is no security in place for e-mail, so some risks may exist with sending information to you through e-mail (e.g., others in the home may access it, the information may be intercepted by others while in transit to your e-mail address, etc.). By providing your e-mail address above, you are agreeing to these risks. You have the right to withdraw your consent at any time by contacting 311.
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