Weekly Programs - 2023/2024
Please complete a separate registration form for each child.
Child's Name
*
First Name
Last Name
Child's Date of Birth
*
-
Month
-
Day
Year
Date
Child's Age
*
Preferred Pronoun
She/Her
He/Him
They/Them
Prefer not to say
Program options
Please fill the day of your program(s) below;
PA Day - November 17th (10:00am-12:30pm) Cedarvale Ravine
PA Day - December 8th (10:00am-12:30pm) Cedarvale Ravine
Mill Pond - October 26th, 2023 (9am-12pm)
March Break 2024 - 9am-12pm (Cedarvale)
March Break 2024 - 1pm-4pm (Cedarvale)
Other
If you are booking a private group, please confirm the date, time and location below
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Parent/Guardian Information
Parent/Guardian 1
*
First Name
Last Name
Preferred pronoun
She/Her
He/Him
They/Them
Prefer not to say
Email
*
example@example.com
Phone Number
*
Please enter a valid phone number.
Parent/Guardian 2
First Name
Last Name
Prefferred pronoun
She/Her
He/Him
They/Them
Prefer not to say
Email
example@example.com
Phone Number
Please enter a valid phone number.
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Emergency Contact Information
Name
*
First Name
Last Name
Phone Number
*
Please enter a valid phone number.
Relationship to Child
*
Approved Names for Pickup (please separate names with a comma)
*
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Medical/Health Information
Does your child have any food, medication or environmental allergies?
*
Yes
No
Please list and explain any allergies
Does your child's allergy require staff to monitor them for symptom, take action if a reaction occurs, or provide emergency medication to them?
Yes
No
Requires an Epi Pen
Does your child have a special health or medical condition?
*
Yes
No
If your child has a special health or medical condition, please explain here.
Please provide any additional information about your child that would be useful for the Roots 2 Rise staff to be able to best support your child's needs (i.e. emotional, cognitive, behavioural, physical, etc.)
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Name
*
First Name
Last Name
Signature
*
Clear
Date
*
-
Month
-
Day
Year
Date
Thank you for your interest in Roots 2 Rise Outdoors!
Once your group has the minimum participants required for confirmation, the payment information, waiver and program information package will be sent to you.
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