Little Steps Registration

Little Steps Registration Form
Child's Name:

First NameLast Name
Birth Date:

DayMonthYear
Age at time of Registration:
Child’s Special Needs / Allergies / Concerns:
Parent/Carer:

First NameLast Name
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Mobile Phone Number
E-mail:
Relationship to Child:
Signature
Date

DayMonthYear
Date
Once we have confirmed your registration with Little Steps, you will receive further information regarding our Privacy Policy and how you can join our Facebook group.

Thank you for taking the time to complete this form.
Should be Empty:

Little Steps Registration Form