REGISTRATION

 

 

 

 

 

 

 

I am registering
First Name Last Name Gender Male Female First Language spoken at home
Address unit # Street # Street Name City Postal Code
Home Telephone Cell Telephone Work Phone Email Address:
Emergency Contact Name Emergency Contact Telephone
Child's First Name Last Name Birth Date Gender Male Female
Child's First Name Last Name Birth Date Gneder Male Female
Program Love of Words
English Classes
Tutoring Training
Child Minding Training
Job Club
Drop In
Summer Literacy
Developing a Voice
Tutoring
Other