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Sign Information

Email Address * An email will be sent to the email address you have specified
Password *
Confirm Password *

Parent/Guardian Information

First Name * Last Name *
Home Phone No * Cell Phone No Work Phone No
Home Address * City * Province / State * Postal / ZIP Code * Canada USA

Member/Children Information

Member # 1
Gender * M F
First Name *
Last Name *
Date of Birth (mm/dd/yyyy) *
Member # 2
Gender M F
First Name
Last Name
Date of Birth (mm/dd/yyyy)
Member # 3
Gender M F
First Name
Last Name
Date of Birth (mm/dd/yyyy)
Member # 4
Gender M F
First Name
Last Name
Date of Birth (mm/dd/yyyy)
Member # 5
Gender M F
First Name
Last Name
Date of Birth (mm/dd/yyyy)
Member # 6
Gender M F
First Name
Last Name
Date of Birth (mm/dd/yyyy)

Person(s) Authorized to Pick up Student (ID may be needed at the pickup)

Name:*
Name:

Emergency Contact

Name:*
Phone No:*
Relationship*
Name:
Phone No:
Relationship

Special Needs / Comments

Please describe allergies/medical conditions/special needs for all above children

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