The Lawrence Park School Ltd.

Application for Admission:

SUMMER PROGRAM

 

Child’s Name: __________________________________________________________

(Last)                                                            (First)                                           (Middle)    

Home Address: ________________________________ Postal Code: ______________

Telephone No.:___________________  Child’s Date of Birth: _____________________

 

	Mother	Father
Full Name
Phone no.
Cell phone no.
Address
Occupation
Business Name & Address
Business Telephone
Email address

         

Ontario Health Number  _____________________  Allergies _____________________

 

Child’s Doctor ________________________________  Phone no. _________________

Address _______________________________________________________________

 

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PERSON TO BE CONTACTED IF PARENTS CANNOT BE REACHED:

Name:   ____________________ Address:     _________________________________

Business phone no.__________ Home phone no.  _____________ Relationship to child  _____________

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Siblings:

Name __________________________  Age _______  Sex ________

Name __________________________  Age _______  Sex ________

Other people living in the home ______________________________

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WEEKS ATTENDING (2012):             CIRCLE DATES YOU WOULD LIKE                          9am – 12pm                                           July 9 — 13                   July 16 - 20                   July 23 — 27                 July 30 — Aug 3                                                              Aug 13 — 17                              Aug 20 — 24                                           Aug 27— 31

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Date of Application ______________________  Signature  _______________________

 

Fees due May 18, 2012