WIBCA Saturday Morning Tutorials Registration Form
For Students

Saturday Morning Tutorials will be held every Saturday from 10:00 to 12:00 at The West Island Black Community Association Building (48 4e Av S, Roxboro, QC H8Y 2M2) starting September 14th 2019

For more information please contact education@wibca.org or call at (514) 683-3925
Email address *
Student Information
Last Name *
Your answer
First Name *
Your answer
Age *
Your answer
Sex
Street Adress *
Your answer
Apartment Number *
Your answer
Postal Code *
Your answer
City *
Your answer
Home Telephone *
Your answer
Mother's Name *
Your answer
Mother's Address *
Your answer
Mother's Phone Number *
Your answer
Father's Name *
Your answer
Father's Address *
Your answer
Father's Phone Number *
Your answer
Legal Guardian's Name (if applicable)
Your answer
Legal Guardian's Address (if applicable)
Your answer
Legal Guardian's Phone Number (if applicable)
Your answer
Emergency Contact's Name *
Your answer
Emergency Contact's Phone Number *
Your answer
Relation to Emergency Contact *
Your answer
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