REGISTRATION FORM

    Children’s Information

    Medical Information

    Child’s Name

    Health Card Number

    Gender: M or F

    MaleFemale

    Location

    Grade in September

    Date of Birth

    Allergies / Puffers / Special Needs / Any Instructions (ADD, ADHD, PDD, AUTISM) / Comments:*

    CONTACT INFORMATION

    Home Address

    Home Phone

    Contact Email*

    Contact

    Name

    Cell or Home

    Email

    Mother

    Father

    Emergency

    Relationship

    ENROLLMENT FEES INFORMATION

    WEEK

    START DATE

    END DATE

    $240/WK 9AM-4PM

    PRE CARE 7AM-9AM ($20)

    POST CARE 4PM-5:30PM ($20)

    Cost

    1

    July 02

    July 05

    1

    1

    1

    2

    July 08

    July 12

    1

    1

    1

    3

    July 15

    July 19

    1

    1

    1

    4

    July 22

    July 26

    1

    1

    1

    5

    July 29

    August 02

    1

    1

    1

    6

    August 06

    August 09

    1

    1

    1

    7

    August 12

    August 16

    1

    1

    1

    8

    August 19

    August 23

    1

    1

    1

    9 (ONLY CENTRAL PARK LOCATION AVAILABLE)

    August 26

    August 30

    1

    1

    1

    Total Number of Weeks

    Administration Fee $50/Child:

    $50.00

    Subtotal

    HST 13%

    Total Fees:

    Signature*

    Terms of enrollment

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