Jolly Jolly Arts & Reading Registration Form

Payments are currently accepted via e-transfer or cash in-person prior to the start date of the program. 

After completing the registration form, please email payment directions. If e-transfer, email the password and name used on the registration form. E-transfers can be made to info@jollyedu.ca. If paying cash in person, email us to schedule an appointment. 

Registration spots will not be guaranteed until full payment is received. 

Programs must reach at least 3 participants to proceed. If a minimum number of students are not registered, a full refund will be given, using the same method of payment received. If a student is unable to make a class, a school credit will be issued.


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Email *
Student's Name *
First and last name
Full Program Name *
Date and Time of Program Attending  *
Student's Gender *
First and last name
Student's Date of Birth  *
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/
DD
/
YYYY
Parent/Guardian Name(s) *
First and last name
Parent/Guardian Email *
Parent/Guardian Phone Number(s) *
Home Address *

A copy of the student’s immunization record is required. Are you able to provide us with a copy prior to your child's attendance to our centre?


 *

Emergency Contact(s) and Number(s). Please write down the names, phone numbers, and relationship to the child of each contact.


*

I understand that in the event of an accident or illness occurring to my child, the Centre will make every attempt to contact me and/or another person on my child’s emergency contact list. If however, I or the person on the list cannot be reached, I hereby give Jolly Jolly Arts & Reading, its Directors and Employees authority to act on my behalf in case of emergency and to take appropriate steps to have a doctor attend to my child.

I also agree to release and indemnify Jolly Jolly Arts & Reading, its Directors and employees from any and all claims for damages arising from any injury or otherwise related actions to my child as a result of any accident, illness, injury or for any other reason arising from participation in any school activities.


 *

I authorize my child to participate in photographic or video interviews for the use of Jolly Jolly Arts & Reading. I also authorize my child’s photographic images and/or video to be used by Jolly Jolly Arts & Reading for various forms of media to assist in publicity, promotional and marketing purposes  


 *

Please specify any social, emotional or medical concerns that the Centre should be aware of (including any ALLERGIES):

How did you hear about Jolly Jolly Arts & Reading? (Select all that apply)

A copy of your responses will be emailed to the address you provided.
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