Registration
Holiday Program NON MEMBERS - Thursday 15th April 2021 - 4-12 yrs of age 10.30am-1.00pm - Learn - Play - Engage ** please bring along a fruit snack for when you attend the Holiday Program
Event:
Start Date/Time: End Date/Time:
Fee per Student: Room:
* - denotes required fields
Family Information
First Name:* Last Name: *
Mother/Father/Career
Home Phone: Cell #: Work #:
Email:* (Emails are kept confidential)
 
Address: *
City: * State/Prov: * Postal Code: *
Emergency Contact Info
(Not Contact #1 or #2)
 
 
Students entered below will be added to your family's account
 
Additional Information:
 
 
Other Questions/Comments:
 
Credit Card Verification:
   
Card Number: *  
Name as it appears on card: *
Nickname:
Card Expiration Month: *   Exp Year: *
Address Line 1: Address Line 2:
City: State/Prov: Postal Code:*