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Paleo Play / Homeschool Registration / Fall 2022/ Ages 8-11
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Email
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Your email
Child's FIrst Name
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Your answer
Child's Last Name:
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Your answer
Child's Age:
*
Your answer
Parents/Legal Guardian Name(s):
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Your answer
Phone Number (daytime):
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:
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Alternative/Emergency Phone Number:
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Your answer
Street Address:
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Your answer
City/Town:
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Postal Code:
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Email Address:
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Your answer
Does your child have any allergies/medical conditions?
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Yes
No
If yes, please specify
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Will you permit photos and/or video to be taken of your child and displayed and/or used for promotions by Paleo Play? Note: Child's name will NOT be used.
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Please make sure to fill out your Medical + Waiver forms (included in the email that had link to this form).
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Indicate below how you will be returning your forms.
Sending via Email to
paleoplaycanmore@gmail.com
Sending via CanadaPost to 8 West Park Place, Cochrane, AB T4C 1J7
Required
Program are you registering for?
Wednesday's: (Ages 8-11 )Dates: Sept. 21, 28 Oct. 5, 12,19, 26, Nov. 2,9, 16( 1pm to 4:30pm)
Please indicate your method of payment:
*
Fees: 9 Sessions x $35/session = $315.00
Email Transfer (send email to
paleoplaycanmore@gmail.com/
PASSWORD : paleoplay)
Cheque (Payable to Corey Stevens, 8 West Park Place, Cochrane, AB T4C 1J7 )
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A copy of your responses will be emailed to the address you provided.
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