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
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
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
Parents/ Guardians Name (Mother/ Father) * If registered in the program
Please include mothers/ guardians full name. Example, MacDonald, Mary
Parents/ Guardians Contact Information *
List contact information for both mother/ guardians here. For example, 436-1234 (h), 888-1234 (w), 954-1234 (C)
Parents/ Guardians Email *
Children's Names and Age
First name followed by Age
Additional Information or Comments
Submit
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