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2021 Summer Holiday Program! WATER PLAY> GYMNASTICS> TUMBLE>WATER PLAY>TRAMPOLINE Enroll now for our 2021 Summer Holiday Program for a fun filled session of gymnastics and water play ! What a great way to spend your January summer holiday s in 2021.
Event:
Start Date/Time:
End Date/Time:
Fee per Student:
Room:
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Family Information
First Name:
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Last Name:
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Mother/Father/Career
Carer
Department
Father
Grandparent
Guardian
Mother
Nanny / Au Pair
Other / Accounts
Parent
Self
Step Parent
Home Phone:
Cell #:
Work #:
Email:
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(Emails are kept confidential)
Address:
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City:
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State/Prov:
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Postal Code:
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Emergency Contact Info (Not Contact #1 or #2)
Students entered below will be added to your family's account
Add New Student #1:
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Student's First Name:
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Last Name:
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Student Gender:
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Male
Non Binary
Birth Date:
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(format=dd/mm/yyyy)
Disabilities (Leave blank if NONE):
Allergies (Leave blank if NONE):
Medications (Leave blank if NONE):
Photo permission (Y/N)?:
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Add New Student #2:
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Student's First Name:
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Last Name:
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Student Gender:
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Female
Male
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Birth Date:
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(format=dd/mm/yyyy)
Disabilities (Leave blank if NONE):
Allergies (Leave blank if NONE):
Medications (Leave blank if NONE):
Photo permission (Y/N)?:
*
Add New Student #3:
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Student's First Name:
*
Last Name:
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Student Gender:
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Female
Male
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Birth Date:
*
(format=dd/mm/yyyy)
Disabilities (Leave blank if NONE):
Allergies (Leave blank if NONE):
Medications (Leave blank if NONE):
Photo permission (Y/N)?:
*
Add New Student #4:
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Student's First Name:
*
Last Name:
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Student Gender:
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Female
Male
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Birth Date:
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(format=dd/mm/yyyy)
Disabilities (Leave blank if NONE):
Allergies (Leave blank if NONE):
Medications (Leave blank if NONE):
Photo permission (Y/N)?:
*
Add New Student #5:
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Student's First Name:
*
Last Name:
*
Student Gender:
*
Female
Male
Non Binary
Birth Date:
*
(format=dd/mm/yyyy)
Disabilities (Leave blank if NONE):
Allergies (Leave blank if NONE):
Medications (Leave blank if NONE):
Photo permission (Y/N)?:
*
Additional Information:
Other Questions/Comments:
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Visa
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Name as it appears on card:
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Nickname:
Card Expiration Month:
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Exp Year:
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Address Line 1:
Address Line 2:
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