Community Service Directory Community Service Directory “By Military Families, For Military Families”Are you part of a military family? Do you have a service to provide to our community? Are you self-employed and offer products and/or services to our community? Would you like an opportunity to advertise your service and/or business in our new Community Service Directory? Question Title 1. Contact Information Name: * Business Name: * Phone Number: * Email address: * Website (optional): Question Title 2. Affiliation (check applicable box): Military Family Veteran Family Reservist Family Question Title 3. Select all geographical areas in which you are able to provide service (check all that apply): Shilo Sprucewoods Brandon Wawanesa Carberry Other (please specify) Question Title 4. Type of service/s provided (check all that apply): Yard/driveway Maintenance (grass cutting, leaf collection, snow removal, etc.) Childminding (babysitting, home-based daycare, etc.) Pet Care (dog walking, pet sitting, pet waste cleanup, etc.) House Care (house sitting, house cleaning, etc.) Home-based Business (Avon, Party Lite, Designs by Debbie, etc.) Food/Meal Services (food prep, grocery shopping, meal delivery, etc.) Other (please specify) Question Title 5. Additional service details (if required): Question Title 6. Acknowledgement of Conditions: I acknowledge that the Shilo Military Family Resource Centre is not responsible for screening individuals who have requested/received the Community Service Directory; I acknowledge that it is my responsibility to collect payment for services; I acknowledge that the Community Service Directory will be distributed publicly; I acknowledge that it is my responsibility to update my information as required. YES (by clicking yes, I certify that I understand and agree, to the terms as stated above) Question Title 7. Consent of Parent/Guardian (for service providers under the age of 18) I acknowledge that it is my responsibility to monitor and supervise interactions between my child and individuals to whom they provide services to; Based on my acknowledgement as described above, I agree that my child may register in the Community Service Directory. YES (by clicking yes, I agree to all the Conditions outlined above & that I am the parent/legal guardian of the minor mentioned above.) Question Title 8. Parent/guardian Information (if registrant is under 18): Name: Phone Number Question Title 9. FOR OFFICE USE ONLY - DO NOT COMPLETE Information provided by: Application form processed? Done