Registration for EarlyON : LINCOLN

Registration for EarlyON : LINCOLN

Located inside Providence Church 4845 King St., Beamsville. Drop-in hours: Mon-Fri 9am-12pm and 1pm-4pm.
All families are required to register for their FIRST visit.

If you are attending an EarlyON Centre operated by Port Cares for the first time please complete this full registration. This is important information that we need on file for things like emergency contact, any sort of contact tracing etc. Thank you for your cooperation. HOURS: Mon-Fri 9am-12pm and 1pm-4pm.
What you should know before you visit:
- We are back to DROP IN ! Booking a visit is no longer required.
- We do not ask for proof of vaccination.
- Adults are not required but highly recommended.
- You may bring your own snacks / food / drinks at this time. Some locations may have a separate snack area.
- We clean toys/items and high-touch surfaces in between visits/ groups.
  
  If you have any questions, please contact us directly at 905-401-3499 or earlyon@portcares.ca.
Child 1

First Name Last Name
Child 1 Date of Birth:

Month Day Year
Date
Child 2

First Name Last Name
Child 2 Date of Birth:

Month Day Year
Date
Child 3

First Name Last Name
Child 3 Date of Birth:

Month Day Year
Date
Parent / Guardian Registering: *

First Name Last Name
Your Email *
example@example.com
Phone Number *
Please enter a valid phone number.
Emergency contact *
Name, phone number and relationship to you.
Please list any other PARENT or CAREGIVERS' names below that might also bring your child(ren) to our location. Please include relationship to child.
ex. Rachel Green - Aunt
Your Address *

Street Address

Street Address Line 2

City Province

Postal Code
How do you prefer to be contacted? *

Email Phone
I'd like to be contacted via email about upcoming events with EarlyON, activities to do at-home, news and announcements and more. (monthly) *

Yes, please! No, thank you!
Staff may take photos of child / families while they're involved in activities at our centres. Do you give consent to having your child photographed? Photos could be used on our social media and promotional materials. *

Yes (please include signature below) No
Signature for photo consent *

Clear
Please list full names and ages of the children attending this visit: *
Date of Visit Request *

Month Day Year
Can only book one date at a time.
Please select a time-block. Visitors can arrive at any time during the block and stay for as long as they wish. *

9:00am - 11:30am 1:00pm - 3:30pm
Parent / guardian's name that is attending: *

First Name Last Name
Email to send confirmation to: *
example@example.com
The attending adult has been double-vaccinated for 14 days or more. *

Yes No
How many ADULTS will attend this visit? *
How many CHILDREN will attend this visit? *
Please verify that you are human *
Should be Empty:

Registration for EarlyON : LINCOLN

All families are required to register for their FIRST visit.