Intellidance at Ermineskin Community Centre

Intellidance at Ermineskin Community Centre - Registration Form - April 17 to May 29, 2020

Fridays from 10:15-11 am
*Registration and payment are due at first class or to the ECL office prior.
Parent/Guardian Name *

First Name Last Name
Phone Number *

Area Code Phone Number
Email *
example@example.com

Address *

Children's Information
Child 1's Name *

First Name Last Name
Child 1's Date of Birth *

Month Day Year
Date
Health Concerns, Allergies *
Child 2's Name

First Name Last Name
Child 2's Date of Birth

Month Day Year
Date
Health Concerns, Allergies
Emergency Information
Contact Name *

First Name Last Name
Phone Number *

Area Code Phone Number
Relationship *
Payment

ECL Members $70 , Non-members $84 (if using PayPal additional administrative fee of $3.50 is charged)
Ermineskin Community League Membership Number
Select your form of payment

Cash (bring to first class) Cheque made out to Ermineskin Community League (bring to first class)
Paypal
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Class Registration Fee, ECL Members $ 73.50 CAD

Class Registration Fee, Non-Members $ 87.50 CAD

Total $ 0.00 CAD
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Intellidance at Ermineskin Community Centre - Registration Form - April 17 to May 29, 2020