Required fields are marked with asterisks (*)

After School Club Registration Form

Personal information contained on this form is collected under the authority of the Municipal Act, 2000 and will be used to respond to your request. Questions about this collection should be directed to the Coordinator, Recreation 905-875-7252 ext.2613.

Parent/Guardian Contact Information

Parent/guardian name:

Email address:

Street address:

Town/city:

Postal code:

Home phone:

Parent/guardian #1 business phone:

Parent/guardian #1 cell phone:

Parent/guardian #2 business phone:

Parent/guardian #2 cell phone:

Emergency contact name:

Emergency contact relationship:

Emergency contact phone:

Part A: Participant Information

Please answer the following series of questions about each participant.
Additional participants can be added at the end of the series of questions by choosing the blue "Add another participant" button.

Participant Number 1

Participant name:

Participant birth date:

Is extra support required for participation at school?

Yes

Does your child suffer from life-threatening allergies?

Yes

Does your child require any medications or epi pen?

Yes

Will your child sign him/herself out the the program? (Please note: Children must be 10 years of age or older to sign themselves out)

Yes

Name of school:

What grade will your child be entering in the fall of this year?

Start Date of School Term:

Add another participant Remove a participant

Part B: Program Information

Please check the option you need for After School Club

After School Club (6-12 years)

Kindergarten After School Club

Before registration is complete, a valid credit card must be added on your family account, as payments will be processed monthly by credit card.

Have you added a valid credit card to your family account:

Yes

Do you want to receive the recreation e-newsletter?

Yes