Family Place Program Registration Form

Please complete this form to register for our programs. If you wish to register for an additional program(s) simply submit another form or comment in the comment section. If you are interested in registering for our Reggio Inspired Early Learning Program please call Laura Quinn Graham at 436-1348 ext. 1 or email: familyplace@eastlink.ca or mention it in the comments box. If you would like more information about our programs and services please call 436-1348, visit us at: www.familyplacepei.com or our Face Book group: www.facebook.com/groups/familyplace

1. Program Registering For

Please specify program(s) Use other forms for children's licensed programs

This is a required question

1. If you selected 'Parenting Program' Above please specify which parenting program (if applicable)

Please specify program(s) Use other forms for children's licensed programs

This is a required question

2. If you selected 'Parenting Program' Above please specify which parenting program (if applicable)

Please specify program(s) Use other forms for children's licensed programs

This is a required question

Parents/ Guardians Name (Mother/ Father) * If registered in the program

Please include mothers/ guardians full name. Example, MacDonald, Mary

This is a required question

Parents/ Guardians Contact Information

List contact information for both mother/ guardians here. For example, 436-1234 (h), 888-1234 (w), 954-1234 (C)

This is a required question

Parents/ Guardians Email

This is a required question

Children's Names and Age

First name followed by Age

This is a required question

Additional Information or Comments

This is a required question