IHP - Virtual I'm Home Program Registration Form

VIRTUAL I’M HOME PROGRAM
REGISTRATION FORM
(One Per Child)

London Children's Connection’s I’m Home Program provides children ages 10 and up
with the knowledge and the tools they need to be safe when home alone.

This free online program is being offered exclusively to London families through
a convenient virtual course, packed with helpful information, videos, and activities.

It will also give parents the peace of mind that they have taken the necessary steps to
ensure their child is ready for this new responsibility.

To register, please complete the form below.

Once submitted, you will automatically receive an email to learn

how to access the I'm Home Program through Canvas Instructure.

Child First Name *

Child Last Name *

Age of Child *

Parent/Guardian Last Name *

Parent/Guardian First Name *

Area of Residence *

Please specify city of residence: *

Daytime Phone Number *

Email Address: *

I acknowledge that submitting this form serves as my signature.

I'm Home Program

London Children's Connection

346 Wonderland Rd. S. London, Ontario

519-471-4300

www.lcc.on.ca/im-home