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* Indicates required information
Child's name: *
Day of Birth: *
Health card number:
Does your child have any medical conditions the staff should be aware of (i.e. allergies)?
Indicate any special medical attention your child may require:
For possible future advertising we need consent from parent to include photographs and video of children *
Select program date(s): *
April 12, 2019 (full day)
April 22, 2019 (Easter Monday, full day)
May 31, 2019 (full day)
June 28, 2019 (WRDSB only, full day)
Contact name(s): *
Home phone: *