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McKenzie Towne 2018 Fall Registration
Any information that is required must be completed fully or registration will not be accepted.
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* Indicates required question
Email
*
Your email
Child's Last and First Name
*
Your answer
Parents First and Last Names
*
Your answer
Phone Number
*
Your answer
Child's Mailing Address
*
Your answer
Parent's Mailing Address if Different than Child's(child resides in more than one home)
Your answer
Emergency Contact Name (Can not be yourself)
*
Your answer
Emergency Contact Phone Number
*
Your answer
Emergency Contact Mailing Address
*
Your answer
Child's Birthdate
*
Your answer
Child's Alberta Health Care Number
*
Your answer
Medical/Allergies
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Your answer
Medication/Inhalers/Epi Pens Needed?
*
YES
NO
Immunizations Up to Date?
*
YES
NO
Walk Home Alone?
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YES
NO
Additional Contacts
Your answer
Name(s) for tax receipts to be addressed to. If multiple people please add percentage. (Example, mom pays 50%, dad pays 50%)
*
Your answer
Email(s) for tax receipts to be sent to.
*
Your answer
$50 Non Refundable Registration Fee (Per family)
*
Cheque (The Adventures)
Etransfer (
the-adventures@shaw.ca
) password (Adventures)
Cash
Signature of Parent (Type full Name)
*
Your answer
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