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Paleo Play / AfterSchool Program Registration / Spring 2022
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Email
*
Your email
Child's First Name:
*
Your answer
Child's Last Name:
*
Your answer
Child's Age:
Your answer
Which program are you registering for?
*
Session A: 1pm to 4.30pm / designated Fridays / April 29, May 13, 27, June 10, 24
Session B: 1pm to 4:30pm / Friday's / April 22, May 6, 20, June 3, 17
Other:
Parents/Legal Guardian Name(s):
*
Your answer
Phone Number (daytime):
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Your answer
Alternative/Emergency Phone Number:
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Your answer
Street Address:
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Your answer
City/Town:
*
Your answer
Postal Code:
*
Your answer
Does your child have any allergies/medical conditions?
*
Choose
Yes
No
If yes, please specify
Your answer
Will you permit photos and/or video to be taken of your child and displayed and/or used for promotions by Paleo Play?
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We will not publish childrens' names with any images.
Choose
Yes
No
Please make sure to fill out your Medical + Waiver forms (which you will receive via email)
*
Indicate below how you will be returning your forms.
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Sending via Email to paleoplaycanmore@gmail.com
Sending via CanadaPost to 8 West Park Place, Cochrane, AB T4C 1J7
Please indicate your method of payment.
*
FEES: : [ 5 sessions x $40/day = $200 ]
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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