9550 Pine Valley Drive, Woodbridge ON, L4L 1A6 (905) 832-2289 www.kortright.org 2015 KORTRIGHT FOREST SCHOOL REGISTRATION FORM Participant’s Name____________________________________________ Date of Birth ________/_______/_______ Sex_____ Month Day Year Parent/Guardian Name________________________________________ Address______________________________________ City ____________________________ Postal Code_______________ Email ________________________________________ Home phone______________________ Business phone_________________________ Cell phone________________________ Person dropping off________________________________ Person picking up________________________________________ *Forest School runs 9:00 am – 12:00 pm daily. Each session is $500. Forest School is for potty trained children ages 2 ½ to 5 years old. Spring Session: Weekdays, Monday June 8 – Friday June 19, 2015 Fall Session: Weekdays, September 28 – Friday October 9, 2015 We must receive REGISTRATION FORMS and FEES for your child to be considered as registered. A separate form must be filled out for each child being registered. Please ensure you have COMPLETELY filled out the application form, image release form and the Waiver form in order to secure your reservation. Emergency Contact :_________________________________________________ Relationship: ______________________________________Tel: _______________________________________________ Medical Information Family Doctor: ____________________________________ Tel:________________________________________________ Ontario Health Card No: ____________________________ Activity Restrictions:___________________________________ _____________________________________________________________________________________________________ Medical Restrictions: ___________________________________________________________________________________ Behavioural/Emotional concerns:___________________________________________________________________________ Allergies or Dietary Restrictions: __________________________________________________________________________ Other Relevant Information that will assist us in making your child's Forest School experience as successful and rewarding as possible: ________________________________________________________________________________________________________ ________________________________________________________________________________________________________ How did you hear about Kortright Forest School ?____________________________________________________________ Method of Payment Amount paid: _____________ Cash (in person only) VISA Cheque made payable to: Toronto and Region Conservation M/C AMEX Card #: __________________________________________ Expiry Date: ______________________________________ Signature: ________________________________________ CANCELLATION POLICY: Written notification of a cancellation must be received. Cancellations made at least four weeks before the start of your session will receive a refund of 75 per cent of the fees. Cancellations made within a four-week period will not receive a refund. There is no refund for days missed. Please email completed forms to [email protected] or Fax them to 416-661-6610 Attention: Caroline MacGillivray For Forest School questions and inquiries please call 416-667-6295 ext. 602 Also refer to Waiver Form, Image release form and Forest School FAQ Form