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Please Note: No refunds for online purchases.

* Indicates required information

First child
 

Child's name: *

Month Day Year

Day of Birth: *

Health card number:

Gender: *  Female   Male

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 *

Yes   No

 

Select program date(s): *

April 22, 2019 (Easter Monday, full day)

May 31, 2019 (full day)

June 28, 2019 (WRDSB only, full day)


Emergency contact information
 

Contact name(s): *

Home phone: *

Work phone: