Cedarvale Ravine Spring Registration Form Additional

Child's Name *

First

Last

Child's Date of Birth *

Child's Age *

Preferred pronoun

She / Her
He / Him
They / Them
Prefer Not To Say

How did you hear about us? *

From a friend
Social Media
Newsletter
Word on the street
Referral from another organization
Google search
Other

Please choose your program(s) below

Mondays: 3:30pm-5:30pm (Ages 4-8) (Markdale Preschool Entrance) *Cedarvale and Leo Baeck pick up available
Saturdays: 10am-11:30am (Caregiver/Child) (Suydam Park Entrance)
Saturdays: 1pm-3pm (Ages 4-8) (Suydam Park Entrance)
Sundays: 10am-12pm (Ages 4-10) (Suydam Park Entrance)
Sundays: 1pm-3pm (Ages 4-10) (Suydam Park Entrance)

Pick up required - $50 additional cost for school pick up

Passover Break; April 22nd - April 26th (9am-12pm)

Full week (Monday - Friday)
Drop In - Monday, April 22nd
Drop In - Tuesday, April 23rd
Drop In - Wednesday, April 24th
Drop In - Thursday, April 25th
Drop In - Friday, April 26th

If you have a group or are interested in a day/time that is not listed above, please provide this information here. Please note, we will do our best to accommodate your request. If the program you are interested in is full, we will add you to the waitlist and let you know when a spot opens up.

Parent/Guardian Information *

First

Last

Preferred pronoun

She / Her
He / Him
They / Them
Prefer Not To Say

Email *

Phone Number *

Address

Address Line 1

Address Line 2

City

State / Province / Region

Postal Code

Country

Parent/Guardian 2 Information

First

Last

Preferred pronoun

She / Her
He / Him
They / Them
Prefer Not To Say

Phone Number

Emergency Contact Name *

First

Last

Phone Number *

Relationship to Child

Approved Names for Pickup (please separate names with a comma)

Does your child have any food, medication or environmental allergies *

Please list and explain any allergies

Does your child's allergy require an Epi Pen

Does your child have a special health or medical condition?

Please explain here any special health or medical condition.

Please provide any additional information about your child that would be useful for Roots 2 Rise staff to be able to best support your child's needs (i.e. emotional, cognitive, behavioural, physical, etc.)

Name *

First

Last

Email *

Date / Time

Code