JR Wilcox after school program

Little Hoopers Tuesdays or Wednesdays 3:30-4:30

Tuesdays JK-grade 1 Wednesdays grade 2-grade 4
Athlete Information
Child's Name*

First Name Last Name
Guardian / Parents Names*

First Name Last Name
Guardian Cell Phone number

Area Code Phone Number
E-mail*
Teachers name and room number
Which session are you registering for?*

September 17-November 5th (Saturdays 8 weeks)November 12- January 14 (Saturdays 8 weeks)
Which session:*

Tuesdays JK-Grade 1Wednesday Grade 2-4
Emergency Contact & Health Information
Emergency Contact's Name*

First Name Last Name
Relationship*
Health Card Number / Card Date
Does your child have any allergies, chronic illness, or medical conditions that would limit high level activtiy?*

YesNo
Please describe*
Parental Permission For Emergency Treatment In the event of illness or accident, I give my permission for emergency treatment by qualified medical personnel for my child, and I authorize the person in charge to take my child to: I give consent for the facility to secure any and all necessary emergency medical care for my child.
Release of Liability I expressly assume the risk of injury, death, and/or illness arising from any cause, and agree to waive the right to pursue any claim against Little Hoopers and the persons in charge.
I have read and agree to the above conditions*

YesNo
Confirmation E-mail*
Signature*

Clear
Important Notes

· Fee: $160 + HST which is a total of 180.80 per participant for 8 weeks. You can send an email transfer to torontogauchos@gmail.com. In the message please indicating your childs name.

Pick up:

The session will begin at 3:30-4:30.

Please pick up your child at the main doors at 4:30.
Which time slot?*

10:00-11:00am beginner11:00am-12:00pm intermediate12:00pm-1:00pm advanced
Should be Empty:

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Little Hoopers Tuesdays or Wednesdays 3:30-4:30