Contact's Name
*
First Name
Last Name
Student's Name
*
First Name
Last Name
Has STUDENT previously been in our program
*
Yes
No
Birthday
-
Year
-
Month
Day
Date Picker Icon
Register another parent or grandparent?
Yes
No
Student's Name
*
First Name
Last Name
Has STUDENT previously been in our program
*
Yes
No
Birthday
-
Year
-
Month
Day
Date Picker Icon
Contact's Phone Number
*
-
Area Code
Phone Number
Contact's E-mail
*
Calculate final cost
*
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( X )
Weekdays 1pm OR 4pm
$38.00 CAD
$
38.00
CAD
Weekdays 5pm
$48.00 CAD
$
48.00
CAD
Weekdays 6pm
$58.00 CAD
$
58.00
CAD
Weekdays 7pm
$68.00 CAD
$
68.00
CAD
Weekends
$68.00 CAD
$
68.00
CAD
Subtotal
$0.00 CAD
$
0.00
CAD
Tax
$0.00 CAD
$
0.00
CAD
Total
$0.00 CAD
$
0.00
CAD
Debit or Credit Card
First Name
Last Name
Credit Card Number
Security Code
Expiration Month
January
February
March
April
May
June
July
August
September
October
November
December
Expiration Month
Expiration Year
2026
2027
2028
2029
2030
2031
2032
2033
2034
2035
2036
2037
2038
2039
2040
2041
2042
2043
2044
2045
Expiration Year
Submit Parent/Grandparent
Should be Empty: