CT Wee College
Student's Full Name
*
First Name
Last Name
Student's Gender
*
Male
Female
Student's Date of Birth
*
-
Month
-
Day
Year
Date
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Phone Number
*
Please enter a valid phone number.
Home Church
Does the student currently attend preschool, day care, Sunday schools or other programs? (Please specify)
*
Please tell us a little about your child and their personality. This will help us prepare for their time in class. (Example: shy, they like to read & colour, this is the first time in a class setting, etc)
*
Medical Information
Provincial Medical Number (6 digits)
*
Provincial Medical Number (9 digits)
*
Does the student have any allergies? What are they?
*
Are there any medical needs or concerns we should be made aware of?
Guardian and Emergency Contact
Primary Guardian Name
*
First Name
Last Name
Relationship to Student
*
Email
*
example@example.com
Contact Number
*
Please enter a valid phone number.
Secondary Guardian Name
First Name
Last Name
Relationship to Student
Email
example@example.com
Contact Number
Please enter a valid phone number.
Emergency Contact Name
*
First Name
Last Name
Relationship to Student
*
Contact Number
*
Please enter a valid phone number.
I will be paying the $85 registration fee by:
*
Using the online payment option on this form
Paying at the church office (cash, cheque, credit card, debit)
Calling the church office with my credit card information
Sending a cheque in the mail to the church office
My Products
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Wee College Registration
$
85.00
CAD
Credit Card Details
First Name
Last Name
Credit Card Number
Security Code
Card Expiration
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