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Please Note: No refunds for online purchases.

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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 *

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Select program date(s): *

Emergency contact information

Contact name(s): *

Home phone: *

Work phone: