Registration Form for Kids & Teens Courses (Gr. 3-10) Summer 2012

Summer 2012 Registration for Kids & Teens Courses (Gr. 3-12)

Please register one student at a time.

IMPORTANT NOTE ABOUT ONLINE REGISTRATIONS: Please note that the completion of a registration form does not guarantee a space in your selected course. You will be contacted if the class is full or if there are any further questions regarding your registration. A written confirmation will be sent to your home within 10 business days.

*Required fields

Student Information
*Student's Name
*Status	New Student Returning Student
*Date of Birth (mm/dd/year)	*Age
*How did you hear about the school?
If you selected "Other" - how did you hear about us?
Parent or Guardian 1
*Name
*Relationship to Student	Mother Father Guardian
*Email Address
Work Phone	Ext.
Cell Phone
Parent or Guardian 2
Name
Relationship to Student	Mother Father Guardian
Work Phone	Ext.
Cell Phone
Address
*Home Address
*City
*Province
*Postal Code
*Home Phone
Emergency & Health Info
*Emergency Contact Name (other than parent or guardian)
*Emergency Contact Phone
*Does the child have any allergies, medical conditions or special needs?	Yes No
If yes, please explain - please note: all children with life-threatening allergies will receive an allergy form to be returned to the school's office before the first class
Health Card Number	Why do we ask for this?
School & Pickup Info
*School Attending
*Grade as of Fall 2012
*The following individuals are authorized to pick-up the above child from the School (please include parents / guardians)	*1.
	2.
	3.

Payment Method
I will be paying by Visa or Mastercard Please note:* If you would like to pay by cheque, please print a copy of the Student Information and Course Selection pages of the online registration form and mail them to the school office with your cheque. Those wishing to pay by debit should come to the school office.