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Pre-registration Information Form
* required fields Child's Information Child's Information
*First Name:    
*Last Name:
*Gender: Male Female Male Female
*Birth Date:    
*Address:
*City, Province:
*Postal Code:
*Home Phone #:
Parent / Guardian Information
*Mother's Full Name
*Home Phone #:
*Cell or Business Phone #:
Home or Business Email Address:
   
*Father's Full Name:
*Home Phone #:
*Cell or Business Phone #:
Home or Business Email Address:
Other Information
*Desired Enrollment Date:
 
*Program of Interest:
*Days of Interest:
(check all that apply) 		Monday
Tuesday
Wednesday
Thursday
Friday		 Monday
Tuesday
Wednesday
Thursday
Friday
Other Important Information:
*How did you hear about us?

If other, please specify: