Registration
*
denotes required fields
Referral Information
How did you hear about us?
*
Bing
Facebook
Flyer
former student
Gift Certificate
Google
Halton Hills Parks magazine
Instagram
kijiji
Location/Sign
Newsletter
Newspaper Ad
Oakville Parks Magazine
Oakville Seniors Book
Palermo School
Post Card
Referral
School Gift Certificates
Snapped Oakville
St. Anthony's
Yellow Pages OnLine
Referral Name
Family Information
Family Last Name
*
Where do you live?
Home Address
*
City
*
State/Prov
*
Alberta
British Columbia
Manitoba
New Brunswick
Newfoundland and Labrador
Nova Scotia
Northwest Territories
Nunavut
Ontario
Prince Edward Island
Quebec
Saskatchewan
Yukon
Postal Code
*
Primary Phone
*
Additional Info
Emergency Contact Info
Contact #1
Contact #1 First Name
*
Last Name
*
Type
*
Doctor/Physician
Father
Grandparent
Guardian
Mother
Other
Parent
Step Father
Step Mother
Student
How Can We Contact You?
Home Phone
Cell #
*
Email
*
(Emails are kept confidential)
Confirm Email
*
Contact #2
Contact #2 First Name
Last Name
Type
Doctor/Physician
Father
Grandparent
Guardian
Mother
Other
Parent
Step Father
Step Mother
Student
How can we contact you?
Home Phone
Cell #
Email
(Emails are kept confidential)
Confirm Email
Student #1
Student's First Name
*
Last Name
*
Gender or Preferred Pronouns
*
Female
He/him
Male
Prefer not to say
She/her
They/them
Birth Date
*
Additional Info
Special Needs (Leave blank if NONE)
Allergies (Leave blank if NONE)
Student #2
(Show-Hide Details)
Student's First Name
*
Last Name
*
Gender or Preferred Pronouns
*
Female
He/him
Male
Prefer not to say
She/her
They/them
Birth Date
*
Additional Info
Special Needs (Leave blank if NONE)
Allergies (Leave blank if NONE)
Student #3
(Show-Hide Details)
Student's First Name
*
Last Name
*
Gender or Preferred Pronouns
*
Female
He/him
Male
Prefer not to say
She/her
They/them
Birth Date
*
Additional Info
Special Needs (Leave blank if NONE)
Allergies (Leave blank if NONE)
Student #4
(Show-Hide Details)
Student's First Name
*
Last Name
*
Gender or Preferred Pronouns
*
Female
He/him
Male
Prefer not to say
She/her
They/them
Birth Date
*
Additional Info
Special Needs (Leave blank if NONE)
Allergies (Leave blank if NONE)
Student #5
(Show-Hide Details)
Student's First Name
*
Last Name
*
Gender or Preferred Pronouns
*
Female
He/him
Male
Prefer not to say
She/her
They/them
Birth Date
*
Additional Info
Special Needs (Leave blank if NONE)
Allergies (Leave blank if NONE)
Add Another Student
Required Policies
(Show-Hide Details)
I Agree to All of the Above
Enter your Full Name
*
March 29, 2024
Questions or Concerns
Comments