Small Waves Strong Minds Program Registration
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Parent/Guardian First Name
Parent/Guardian Last Name
Parent E-Mail *
Parent/Guardian Phone Number
How did you hear about this program? *
PARTICIPANT PICKUP INFORMATION
Photo identification of the caregiver picking up your child will be cross-referenced before your child is pick up
What is the first and last name of the caregiver who will be picking up and dropping off your child? *
What is the phone number of the caregiver who will be picking up and dropping off your child? *
PARTICIPANT INFORMATION
Participants First Name:
Participants Last Name:
Participants Date of Birth:
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Age of particpant:
Gender:
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Please indicate any paddling experience (no paddling experience is required).
Please indicate swimming ability (most recent swimming certification):
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Please list any of the participants allergies:
Is the participant on any medications? Please list the medication and frequency:
Does the participant have any past medical history we should be aware of? Or any risk factors we should be aware of?
PROGRAM REGISTRATION
Billing Address (Number, Street, City, Postal Code)
Payment through Email Money Transfer (EMT): Please send your EMT payment to: "youth@sunnysidepc.ca" along with your childs name (all prices already include tax). A receipt will be provided once payment is received.   Full refunds will be given back within 30 days of registration. If we are unable to reschedule the cancelled session a refund will be given for that session. Refunds will also be given back if the session is cancelled due to no part of your own or City of Toronto Public Health Regulations
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