Children's Information Medical Information Child's Name Health Card Number Gender: M or F MaleFemale Family Doctor Name Grade in September Family Doctor Phone Date of Birth Family Doctor Address Allergies / Puffers / Special Needs / Any Instructions / Comments: CONTACT INFORMATION Home Address Home Phone Contact Name Cell or Home Email Mother Father Emergency Relationship ENROLLMENT FEES INFORMATION WEEK START DATE END DATE $170/WK 9AM-4PM PRE CARE 7AM-9AM POST CARE 4PM-6PM CARE HRS *If Applicable Cost 1 July 6 July 10 1 1 1 1 2 July 13 July 17 1 1 1 1 3 July 20 July 24 1 1 1 1 4 July 27 July 31 1 1 1 1 5 August 3 August 7 1 1 1 1 6 August 10 August 14 1 1 1 1 7 August 17 August 21 1 1 1 1 8 August 24 August 28 1 1 1 1 9 August 31 September 04 1 1 1 1 Total Number of Weeks Registration Fee $25/Child: $25.00 Subtotal HST 13% Total Fees: Balance Due: To be added By Owner
