House Next Door Registration Form 2025

House Next Door Registration Form 2026

To sign up your child(ren) for our programmes, you must complete the form below accurately. For After School Programme, School Holiday Programme, Intermediate Youth Group and High School Youth Group
Name

First and middle name(s)Last Name
Preferred Name/Nickname
Birth Date

MonthDayYear
Child's Phone Number
Ethnicity
Gender
Child's Home Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Please provide any medical or dietary restrictions you child has
How did you hear about The House Next Door?

Emergency Contact Information
Please provide the contact information for another trusted adult in case we cannot reach you in an emergency.

It's important that this is different from the main contact information you provided.
Emergency Contact Name

First NameLast Name
Emergency Contact Phone Number
Relationship to Child

House Next Door Registration Form 2026