ࡱ > c e ` a b bjbjo>o> h T T l j & $ ! |$ V " " #5 0 & $ 2 $ $ & $ : REGISTRATION FORM OUTREACH PROGRAMS SPRING 2018 REGISTRATION BEGINS SUNDAY, JANUARY 28, 2018 Register in person: 12:00 noon - 2:00 p.m., Battle Centre No registration forms will be accepted prior to January 28, 2018 Please return your completed registration form along with payment (payable to Reena) to: By mail or in person: Jaime Marco, Outreach Coordinator, Toby & Henry Battle Developmental Centre, 927 Clark Avenue West, Thornhill ON L4J 8G6 Participants Full Name: Date of Birth (m/d/y): Gender: Male( Female( Street Address: City: Postal Code: Full Name of Parent(s) / Guardian: Full Address (if different from that of Participant): Phone Numbers: Home: Work: (mother): (father): Cell: (mother): (father): E-mail Address(es): Have you moved? Yes ( No ( Is this your first Reena program? Yes ( No ( FOR AGES 16 & OLDER: ARE YOU ON THE COMMUNITY NEEDS LIST IN: York Region ( Toronto Region: ( Indicate / explain any allergies and/or changes in medication or behaviour of participant. PLEASE ENSURE YOUR FAMILY MEMBER CARRIES EMERGENCY ID WHEN ATTENDING A PROGRAM I / We give permission for my / our child / family member________________________________________ to go on outings and travel by van / car during their attendance at the above programs. I / We hereby absolve REENA of any responsibility for any injuries that may occur on any outings. I / We give permission for my / our child / family member to be photographed for promotional purposes. Parent/Guardian:_________________________________________________ Witness:_________________________________________________ (print name & provide signature) (print name & provide signature) Date: Date: ___________________________________________________ FOR FURTHER INFORMATION . . . PLEASE CALL Jaime Marco: (905) 889-2690 x 2224 SPRING PROGRAMS 2018 PLEASE NOTE: THERE ARE NO PROGRAMS FROM April 1 - 6, 2018 PROGRAMSDATESCOSTS(TOTALS SUNDAY FRIENDS CLUB NORTH Battle Centre 927 Clark Ave. West Age 3+ No program April 1, 2018 Sunday Mar. 18 May 13 12 noon - 5 pm (1:3 ratio) $392/8 weeks (1:2 ratio) $504/8 weeks (1:1 ratio) $616/8 weeks ( ( ( ATHLETIC CLUB Battle Centre 927 Clark Ave. West Age 10+ No program April 2, 2018 Mondays Mar. 19 May 14 6:00 8:00 p.m. $290 / session (8 weeks) ( SWIM CLUB Garnet William CC 501 Clark Ave. West Age 7+ No program April 3, 2018 Tuesdays Mar. 20 May 15 7:30 9:00 p.m. $165 / session (includes charge for pool) (8 weeks) ( SPECIAL OLYMPICS BASKETBALL Battle Centre 927 Clark Ave. West Age 16+ No program April 5, 2018 Thursdays Mar. 22 May 17 6:30 - 8:30 p.m. $125 / session (8 weeks) + $20 for t-shirt ( COOKING CLUB Battle Centre 927 Clark Ave. West Age 10+ No program April 5, 2018 Thursdays Mar. 22 May 17 6:30 - 8:30 p.m. $300 / session (8 weeks) (PLEASE COMPLETE THE ATTACHED PAYMENT INFORMATION FORM TOTAL COST: ( . 2 3 4 5 I Q a v { | 9 ; P V W ٻpaQpQ hR 5>*CJ OJ QJ \^J hR 5CJ OJ QJ \^J hR 5CJ OJ QJ \^J hr CJ hG" CJ hC CJ hP