Kids and Youth Neuro Functional Table Tennis Programming
September to December 2026
Player's Name
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First Name
Last Name
Players Date of Birth
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Month
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Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Current School Attending
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Name of the school
Parent/Guardian Name
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First Name
Last Name
Parent/Guardian Primary Email
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example@example.com
Parent/Guardian Phone Number:
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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.
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Participant Agree
MEDIA PERMISSION
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Yes
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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
$560.00 CAD
$
560.00
CAD
Mondays 4-5pm and 5-6pm Tuesdays 4-5pm and 5-6pm Wednesdays 4-5pm and 5-6pm Thursdays 4-5pm and 5-6pm
Options
Mondays 4-5pm Sept 14 to Dec 14 2026
Mondays 5-6pm Sept 14 to Dec 14 2026
Tuesday 4-5pm Sept 15 to Dec 15 2026
Tuesday 5-6pm Sept 15 to Dec 15 2026
Wednesday 4-5pm Sept 16 to Dec 16 2026
Wednesday 5-6pm Sept 16 to Dec 16 2026
Thursday 4-5pm Sept 17 to Dec 17 2026
Thursday 5-6pm Sept 17 to Dec 17 2026
Item subtotal:
$0.00 CAD
$
0.00
CAD
10% OFF Sibling rate
$486.00 CAD
$
486.00
CAD
Add this for 2nd child
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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