Summer Program Registration 2019
Email address *
First & Last Name (child): *
Your answer
Gender (child): *
Date of Birth (child): *
MM
/
DD
/
YYYY
First & Last Name (Parent(s)): *
Your answer
Phone Number: *
Your answer
Chosen Session(s): *
(payable via Interac E-Transfer)
Allergies *
Special Considerations *
Emergency Contact (Name & Relationship): *
Your answer
Emergency Contact (Phone(s)): *
Your answer
Permission to use images of child: *
Today's Date: *
MM
/
DD
/
YYYY
Digital Signature: *
Your answer
Submit
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