Student Info 2023/24

Location Attending: *

Which location is your child attending our classes:

JK-grade 2 - - Sprouts - 183 Carlaw Ave

Grade 3+ - - Sprouts Maker Space & Tech Lab/ Fayez1 Dance Academy - 388 Carlaw Ave Unit 101A & 201

Student's Name *

First Name

Last Name

Birth Date *

MM

DD

YYYY

Address *

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Parent/Guardian Name: *

First Name

Last Name

Cell Phone

(###)

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Home Phone

(###)

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Work Phone

(###)

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Parent/Guardian Name

First Name

Last Name

Cell

(###)

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Work

(###)

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Address (if different from above)

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Emeregncy Contact / Authorized for Pick Up

First Name

Last Name

Contact Number

(###)

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Emergency Contact / Authorized for Pick Up

First Name

Last Name

Contact Number

(###)

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Self Walk Home - 11 years and older only.

If your child is 11 years or older you may choose to give them permission to walk home from Maker after class.

Yes - I give permission for my child to walk themselves home

Waiver Forms *

Please check each waiver to agree.

Medical Waiver - I understand that in the event of an accident or illness involving my child, Sprouts staff will make every attempt to contact me and/or my partner. If, however, I or my partner cannot be reached, I hereby give Sprouts – Growing Bodies & Minds, Sprouts Maker Space & Fayez1 Dance Academy and its entire staff the authority to act on my behalf.

Off Site/Field Trip Permission - I give permission for my child to attend any events or excursions that take place off classroom premises.

Photographic Waiver - I give permission for my child's photograph to be taken and used for After School Class activities and only.

Covid Policy - I understand that my child cannot attend after school programming if they are ill, and I will be required to pick them up immediately should they be ill upon arrival.

Date *

MM

DD

YYYY