Brockville After School Program Registration Brockville After School Program Registration Child Name (First, Last)(required) Grade(required) 3 4 5 6 1 2 Parent/Guardian Name (First, Last):(required) Parent/Guardian Relationship:(required) Parent/Guardian Work Phone Number(required) Parent/Guardian Cell Phone Number(required) Parent/Guardian Email Address(required) Emergency Contact Name(required) Emergency Contact Number to be reached at(required) Emergency Contact Work Phone Number Allergies or Health Conditions (enter N/A if none)(required) School attending(required) Discount code I understand that by hitting submit, I am registering for the above mentioned camp with LifeFit Athletics. An invoice will be sent with payment instructions for e-transfer, cash, debit, credit or cheque. (required) Agree and will pay invoice Is transportation by walking school bus required?(required) Yes No I understand that by hitting submit, I am registering for the walking school bus program and give LifeFit Athletics permission to submit my information to the Leeds, Grenville & Lanark District Health Unit in order to take advantage of transportation from my son/daughters school to the Brockville After School Progam. This represents my legal signature. Signature accepting transportation by walking school bus. I give LifeFit Athletics permission to contact me via e-mail with news of upcoming events and discount promotions. Submit Share this:TwitterFacebookLike this:Like Loading...
