2022 Fall Child/Youth Registration Form

Thank you for registering for an Aurora Cultural Centre program. Your registration is almost complete! Please complete the form below for each registrant.

"*" indicates required fields

Name of Registrant:*

First Last

Child/Youth Class or Workshop Name:*

Please select all classes or workshops you have purchased on behalf of the registrant. Please refer to your email confirmation for registration details.

PA Day Program | Ages 4-12 | Sept 23

[AFTER SCHOOL] You Can Uke It! | Ages 8+ | Sept 28 - Nov 16

A Journey Through Art & Time | Ages 4-6 | Oct 1 - Nov 26

Around the World with Art | Ages 7-10 | Oct 1 - Nov 26

Famous Artists & Their Styles | Ages 11-15 | Oct 1 - Nov 26

PA Day Program | Ages 4-12 | Oct 21

PA Day Program | Ages 4-12 | Nov 18

Order ID #:*

This can be found in the top right hand corner of your receipt or in the body of your confirmation email. Example: Order ID # PR123456.

Date of Birth:*

Age:*

Gender:

Male

Female

Not Listed

Please Specify:

Does the registrant have any special needs or medical information?*

Yes

Please indicate any special needs or medical information.*

Please indicate any special needs or medical information. This information is kept strictly confidential and used only to ensure the best possible experience.

Is an Epi Pen required?*

If an Epi Pen is required, please ensure that it accompanies the child at each class.

Yes

Name of Emergency Contact:*

First Last

Primary Contact Number:*

Contact E-mail:*

Relationship to Registrant:*

Name of Secondary Emergency Contact (Optional):

First Last

Contact Number of Secondary Contact (Optional):

Relationship to Registrant:

Do You Need to Submit an Additional Registration Form?

If you purchased a class or workshop registration for more than one (1) individual and are required to submit an additional Registration Form, please select "yes" and choose the corresponding Registration Form type (Adult 16+ or Child/Youth). Once selected, an additional form will populate. If you do not need to submit an additional form, simply select "no" and submit your existing form.

Would you like to submit an additional registration form?*

Yes

What age group?

Adult 16+ Registration Form

Child/Youth Registration Form

Name of Registrant:*

First Last

Child/Youth Class or Workshop Name:*

Please select all classes or workshops you have purchased on behalf of the registrant. Please refer to your email confirmation for registration details.

PA Day Program | Ages 4-12 | Sept 23

[AFTER SCHOOL] You Can Uke It! | Ages 8+ | Sept 28 - Nov 16

A Journey Through Art & Time | Ages 4-6 | Oct 1 - Nov 26

Around the World with Art | Ages 7-10 | Oct 1 - Nov 26

Famous Artists & Their Styles | Ages 11-15 | Oct 1 - Nov 26

PA Day Program | Ages 4-12 | Oct 21

PA Day Program | Ages 4-12 | Nov 18

Order ID #:*

This can be found in the top right hand corner of your receipt or in the body of your confirmation email. Example: Order ID # PR123456.

Date of Birth:*

Age:*

Gender:

Male

Female

Not Listed

Please Specify:

Does the registrant have any special needs or medical information?*

Yes

Please indicate any special needs or medical information.*

Please indicate any special needs or medical information. This information is kept strictly confidential and used only to ensure the best possible experience.

Is an Epi Pen required?*

If an Epi Pen is required, please ensure that it accompanies the child at each class.

Yes

Name of Emergency Contact:*

First Last

Primary Contact Number:*

Contact E-mail:*

Relationship to Registrant:*

Name of Secondary Emergency Contact (Optional):

First Last

Phone Number of Secondary Contact (Optional):

Relationship to Registrant:

Name of Registrant:*

First Last

Class or Workshop Name:*

Please select all classes or workshops you have purchased. Please refer to your email confirmation for registration details.

Order ID #:*

This can be found in the top right hand corner of your receipt or in the body of your confirmation email. Example: Order ID # PR123456.

Gender:

Male

Female

Not Listed

Please Specify:

Primary Number:*

Secondary Number:

Contact E-mail:*

Name of Emergency Contact:*

First Last

Emergency Contact Phone Number:*

Relationship to Registrant:*

Do you have any special needs or medical information?*

This information is kept strictly confidential

Yes

Please indicate any special needs or medical information.*