Individual Registration

Registration form for First Time Child (9am-12pm), Sun Jul 14 2024

Participant's First Name *

Participant's Last Name *

Child's age at the time of course *

Your full name (if not participant) *

Contact Email (please ensure it's correct!) *

Contact phone (preferably cell) *

Referral source (where did you hear about us?) *

Address

City *

Postal Code *

Province

Would you like a receipt? *

Yes

Additional Project 529 shields ($5 +GST each)

Keep with... (type full names of other participants)

Opt out of newsletter subscription? *

Yes

Coupon

Amount

Discount Amount

Tax amount

Gross amount

Payment Method *

Paypal / Credit Card Email Money Transfer

Credit Card Number*

Expiration Date*

Card (CVV) Code*

Card Holder Name*

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