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Ironwomen - SR After School Program Fall 2024
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Contact Us
Clear Form
September 11th - November 27th, 2024
Whitehorse, Yukon
01.
Registrant Information
Registrants
02.
Confirmation
Confirmation
03.
Receipt
Receipt
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Import
Share fields
*
Required
fields
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First Name
*
Last Name
*
Date of Birth
(YYYY
*
-MM-DD)
/
/
No category for this age.
Gender
Home address and postal code
Guardian 1
Guardian 1 Phone Number
-
International Number
Guardian 2
Guardian 2 Phone Number
Guardian 3
Guardian 3 Phone Number
Guardian 4
Guardian 4 Phone Number
Emergency Contact
Emergency Contact Phone Number
Other people for pick up
Iron Women organizers may contact you via email with important program information and updates. In addition to the billing email address on file please let us know who else needs to receive these emails.
Opt in to emails
In the event of an accident, I authorize Iron Women employees to provide my child with required first-aid. If required, I authorize transportation by ambulance to alternate healthcare. I authorize Iron Women to release the information provided in this registration form to medical personnel.
Family Doctor
Family Doctor Phone Number
Yukon Territory Health Care Number
Does your child have any medical conditions that we should know about?
Does your child have any behavioral issues we should know about?
Does your child have any allergies or intolerances? If so, what are they?
Is there anything else you would like to tell us about your child?
Are you a new or renewing member?
*
Member #
*
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Category
*
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Senior grade 5-7
There are no available categories for the age of this registrant.
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Waivers
I have read and agree
*
AY Waiver
Digital signature
(type your name exactly as entered above "
registrants name
")
*
Parent/guardian digital signature
*
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