To sign up, please enter your information below, and we will contact you shortly to schedule an appointment. If you have any questions, please call us at 613-562-5800 ext. 4475. Thanks for your interest! Parent Information Parent's name * e.g., Jane Smith Phone * e.g., 613-555-5555 E-mail address * e.g., jane.smith@example.ca What's the best day/time for your appointment? e.g., mornings, afternoons, evenings, weekends How did you hear about us? Friend, family, colleague, neighbour Magazine ad Radio ad Facebook page Other Other Child 1 Child’s name (1) * e.g., Tim Smith Child's date of birth (1) * mm/dd/yyyy Child's sex (1) * Female Male Other What language(s) does your child speak? * French English Please add any additional comments or child information below. Child 2 Fill this section in if you have a second child. Child's name (2) Child's date of birth (2) mm/dd/yyyy Child's sex (2) Female Male Other What language(s) does your child speak? * French English Please add any additional comments or child information below. Child 3 Fill this section in if you have a third child. Child's name (3) Child's date of birth (3) mm/dd/yyyy Child's sex (3) Female Male Other What language(s) does your child speak? * French English Please add any additional comments or child information below. Child 4 Fill this section in if you have a forth child. Child's name (4) Child's date of birth (4) mm/dd/yyyy Child's sex (4) Female Male Other What language(s) does your child speak? * French English Please add any additional comments or child information below.
