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