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