Child's Information
My child is going to be attending the sessions:
Tuesday Night
Wednesday Morning
Wednesday Night
Thursday Morning
Thursday Night
Friday Morning
Friday Night
First Name
Last Name
Gender
Male
Female
Date of Birth
School Grade
-- None --
Nursery/Pre-school
Kindergarten
1
2
3
4
5
6
7
8
9
10
11
12
Mailing Address
Home City
Home Province
Mailing Postal Code
Health Information
Allergies/Medical Conditions
Is your child bringing any medication with him/her?
Yes
No
If YES, please list the medication:
Parent/Guardian Contact Information
In case of custody agreements, please include the proper form authorizing parental contacts.
Primary First Name
Primary Last Name
Relationship to Child
Mother
Father
Guardian
Mobile Number
Email Address
Secondary First Name
Secondary Last Name
Relationship to Child
Mother
Father
Guardian
Mobile Number
Email Address
Additional Information
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