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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:

 

Parent's Information

 

Parent name: *

Phone: *

Alternate phone:

 

Select program date(s): *

 

If you have a promotion code, enter it here:


Emergency contact information
 

Contact name(s): *

Relationship: *

Home phone: *

Work phone: