Kids and Youth Neuro Table Tennis Program
APRIL to JUNE 2026
Player's Name
*
First Name
Last Name
Players Date of Birth
*
-
Month
-
Day
Year
Date
Current School Attending
*
Name of the school
Parent/Guardian Name
*
First Name
Last Name
Parent/Guardian Primary Email
*
example@example.com
Parent/Guardian Phone Number:
*
-
Area Code
Phone Number
Player's / Participant's Medical Information
Be specific with all medical information
CODE OF CONDUCT Participant: I have read and understand the Code of Conduct attached. I agree to abide by it for the safety and enjoyment of myself and of other participants.
*
Participant Agree
MEDIA PERMISSION
*
Yes
No
Other
Are there any medical or neurofunctional considerations we should be aware of?
*
Yes
No
List all If you clicked YES above
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Vitality Pong Kids Neuro Program – Table Tennis for Brain Development
$400.00 CAD
$
400.00
CAD
Mondays 4-5 and Thursdays 4-5pm
Options
Mondays 4-5pm Apr 27 to June 22nd (No class May 18th)
Thursdays 4-5pm April 30 to June 25th
Subtotal
$0.00 CAD
$
0.00
CAD
Tax
$0.00 CAD
$
0.00
CAD
Total
$0.00 CAD
$
0.00
CAD
Payment Methods
Credit Card
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Google Pay
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