Before and after-school program registration form

I would like to enrol my child in

Transported Before School Program: *

Transported After School Program: *

Both Before and After School Transported Program: *

My child's schedule will be

Full Time Student Mondays – Fridays:

Part Time Student:

Student Information

Student First Name: *

Student Last Name:

Student Date of Birth: *

Student School Name: *

Student School Phone Number:

Student School Principal Name: *

Student School Day Start Time: *

Student School Day Finish Time: *

Does your child principally reside with:: *

Both

Mother

Father

Other Guardian

Student’s Principal Residence

Parent First Name: *

Parent Last Name: *

Email Address: *

Street Address:

City: *

Province: *

Postal Code: *

Home Phone:

Cell Phone:

Employer: *

Job Title: *

Work Phone:

Spouse/Other Parent First Name: *

Spouse/Other Parent Last Name: *

Spouse/Other Parent Address (if different from above):

Spouse/Other Parent Home Phone (if different from above):

Spouse/Other Parent Cell Phone (if different from above):

Spouse/Other Parent Work Phone:

Should an emergency occur and you or your child’s other parent cannot be reached, please supply an Emergency Contact who is authorized to assume responsibility for your child.

Emergency Contact First Name: *

Emergency Contact Last Name: *

Emergency Contact Phone: *

Emergency Contact Phone (Alternate):

I prefer to be contacted by: *

Home Phone

Cell Phone

Work Phone

905-873-2809
Email Us

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Before and after-school program registration form

Contact Us

905-873-2809 Email Us

Subscribe to Newsletter

Before and after-school program registration form

Contact Us

905-873-2809
Email Us