Spring 2017 Registration

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2017 On-Line Registration form for all classes.
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Email *

Learning or Behavioural Concerns *

Select Payment method *

Online Quick Books invoice

Pay in person or mail

Birthdate *

I have read the Consent of Participation *

Yes

May we use your child's photo without names *

Yes

No

2017 August Registration

Please send future updates *

Yes

No

Other Contact Numbers *

Last Name, First Name *

Home Phone xxx-xxx-xxxx *

We accept Visa, and Mastercard..

I want to register for: *

Address *

Name of Parent or Guardian *

Thank you for contacting us! If needed, you will hear back within 48-72 hours.

Sex *

Male

Female

Relationship *

Parent

Guardian

Consent of Participation

I acknowledge that there are risks in any program. I declare that I have accurately disclosed all information regarding
my daughter/son's physical, mental, or medical conditions. I under stand that ProBots Ottawa has tried to create a safe
and controlled enviroment for participation. I waive the rights of my daughter/son to damages or other costs in the event an injury is caused due to participation here.

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