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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 *

Yes   No


Select program date(s): *

January 25, 2019 (full day)

April 12, 2019 (full day)

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: