LINKS Distance Spring Program 2021 Registration
Please fill out the following form to register your student for the Spring term.
Student Information
Full Name of Student *
Date of Birth *
MM
/
DD
/
YYYY
Grade *
Caregiver information
The following information will allow us to contact you (or other provided persons) in order to set up assessments, provide end of term reports or invoices/receipts, and direct us as to where we should deliver program materials.
Primary Caregiver(s) *
Mailing Address *
Email(s) *
Phone Number *
Current School *
Who is Submitting this Registration *
If you answered Other to previous question, please fill in your name and relation to the student below
Program, Date & Time Slots
Part 1 - Please pick on program option *
Part 2 - Please pick one combination *
If OPTION A was chosen refer to Part 3, and if OPTION B is chosen report to Part 4
Part 3 - Please pick at least TWO possible timeslots for your program OPTION A
4:00 pm
5:00 pm
6:00 pm
7:00 pm
Any
OPTION A
Part 4 -Please pick at least TWO possible for your program OPTION B
4:00 pm
5:15 pm
6:30 pm
Any
OPTION B
Note: Every attempt to accommodate requests will be made but due to limited enrollment, your child may be assigned a different time slot for the Distance LINKS Program
Payment
Please select those that apply to you in terms of payment *
Required
Please provide the total of all those selected in the previous question (I.e., If new student assessment fee ($50) and regular registration fee - OPTION A ($500) were selected, please type $550 in the space below) *
Please select one that applies to you in terms of payment options *
Credit Card Payment Information
Is it a Visa or Mastercard?
Visa or Mastercard Number
Visa or Mastercard Expiry date (mm/yy)
Additional Notes or Comments:
IMPORTANT
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