Register Now / Weekend

Recreational weekend program – Registration Form

Relation to Child

First Name

Last Name

Cell Phone

Email Address

Address

City

Province

Postal Code

Given Name

Last Name

Goes By

Birthdate

Enrolment / Weekend

Desired Date

Desired Hours

Diet Restrictions

Allergies

Other Medical Concerns

Does your child receive medication on an ongoing basis?

No Yes

Medication Details

Given Name

Last Name

Birthdate

Enrolment / Weekend

Desired Date

Desired Hours

Diet Restrictions

Allergies

Other Medical Concerns

Does your child receive medication on an ongoing basis?

No Yes

Medication Details

Relation to Child

First Name

Last Name

Cell Phone

Address

City

Province

Postal Code

Authorized for Pickup

Relation to Child

First Name

Last Name

Cell Phone

Address

City

Province

Postal Code