Creative Kids Club Registration

Name of Child *

First Name

Last Name

Date of Birth *

MM

DD

YYYY

Name of Child 2

First Name

Last Name

Date of Birth

MM

DD

YYYY

Name of Parent *

First Name

Last Name

Address *

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Preferred Phone Number *

This number may be used to contact parents/caregivers in case of an emergency.

(###)

###

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Name of Parent 2

First Name

Last Name

I am interested in the walking program from Blythwood Junior Public School (minimum of 6 students needed)

Yes

No

How did you hear about us? *

Returning student

Website

Referred by a friend

Postcard in the mail

Signage

Other

Number of days *

Currently offering 1 or 2 days per week (Tuesdays and Thursdays) starting September 2024. Additional days may be offered based on interest.

Tuesdays - 1 days at $160/mth

Thursdays - 1 days at $160/mth

Tuesdays AND Thursdays - 2 days per week at $320/mth

Yes, I am interested in attending additional days per week (interest list only)

Choose your preferred day(s)

If you are interested in additional days, please choose your prefered option below.

Monday (interest list only)

Wednesday (interest list only)

Friday (interest list only)