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ESE Junior Registration (2023-2024)
Registration for Young Nak EM Junior Students. Please register each child separately if you have more than one signing up.
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* Indicates required question
Child's Last Name
*
Your answer
Child's First Name
*
Your answer
Child's Grade for the new 2023-2024 semester/term
*
Choose
Grade 4
Grade 5
Grade 6
Child's Gender
*
Choose
Boy
Girl
Child's birthday
MM
/
DD
/
YYYY
Please list any allergies your Child has.
*
Your answer
Parent/Guardian's Name(s)
*
Your answer
Parent/Guardian's Email Address
*
Your answer
Parent/Guardian's Phone Number
*
Your answer
Home/Shipping Address (for mailing packages if needed). If you do not feel comfortable sharing, feel free to type in "N/A"
Your answer
OHIP Number (needed in case of emergencies).
*
Your answer
Emergency Contact Name
*
Your answer
Emergency Contact Phone Number
*
Your answer
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