Sign Up – Wild Rhythm Days

1. Parent / Guardian Information

Parent / Guardian 1

First name *

Last name *

Email *

Phone number *

Parent / Guardian 2 (not required)

First name

Last name

Phone number

2. Home Address

Street address *

City *

Postal code *

3. Emergency Contact

Please provide an emergency contact other than the parents/guardians listed above.

Name *

Relationship to child *

Phone number *

4. Authorized Pickup

Please list anyone other than the parents/guardians above who is authorized to pick up your child.

Name

Relationship to child

Phone number

5. Child Information

Child 1

First name *

Last name *

Preferred name, if different

Date of birth *

6. Program Selection

Which day(s) would you like to register your child for?

Mondays - 13 sessions - September 14th - December 14th: $975
No sessions on Labour Day (September 7th) and Thanksgiving (October 12th)

Wednesdays - 14 sessions - September 9th - December 16th: $1,050
No session on Remembrance Day (November 11th)

Mondays & Wednesdays - September 9th - December 16th: $2,025

7. Health & Support Information

Does your child have any allergies?

NoYes

If yes, please describe the allergy, severity, and any required response:

Does your child have any medical conditions, medications, injuries, or other health considerations we should know about?

Does your child have an IEP, or any learning, sensory, emotional, behavioural, communication, or accessibility needs we should know about?

8. Helping Your Child Have a Great Day

Is there anything else you'd like us to know that will help your child feel comfortable, supported, and have a great day with us?

9. Deposit

Have you already paid a $100 deposit?

YesNo

If yes, $100 will be deducted from your total balance.

10. Permissions & Agreements

I confirm that the health and support information provided is accurate to the best of my knowledge.

I authorize Wild Rhythm staff to provide basic first aid and seek emergency medical care if necessary.

I have read and agree to the cancellation and refund policy.

I have read and agree to the program terms and conditions.

11. Photo & Video Permission

Yes, I give permission for photos/videos of my child to be used by Wild Rhythm Days for promotional material.No, I do not give permission.

12. Registration Summary

Child/Children:
Names will appear here

Program(s):
Selected program will appear here

Program Fees:
$0

Deposit Paid:
-$0

Total Due Today:
$0

Wild Rhythm Days Registration