Six week term: MUNCHKINS Class (prep-yr 2)

Parent/Guardian Name *

First Name

Last Name

Phone *

(###)

###

####

Student Name

First Name

Last Name

Date-of-birth

MM

DD

YYYY

Does the student have any health concerns that we should know about prior to beginning classes with us? *

Yes

No

Does the student have any learning or behavioural difficulties that may impact upon classes? *

Yes

No

Do you (student) identify with any of the options below?

First Nations

LGBTQIA+

Neurodiverse

Multilingual

Awesome human being