Register Parent/Grandparent

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
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
Contact's Phone Number *

- Area Code Phone Number
Contact's E-mail *

Calculate final cost *

Weekdays 1pm OR 4pm $ 38.00 CAD

Weekdays 5pm $ 48.00 CAD

Weekdays 6pm $ 58.00 CAD

Weekdays 7pm $ 68.00 CAD

Weekends $ 68.00 CAD

Subtotal $ 0.00 CAD Tax $ 0.00 CAD Total $ 0.00 CAD

Credit Card
First Name	Last Name
Credit Card Number	Security Code
Expiration Month	Expiration Year

Should be Empty: