Child Information

* 1. Child's First and Last Name:

* 4. Child's Allergies:

* 5. Is this your child's first time participating in this online mentorship program?

* 6. Parent Contact Information

* 7. Please check boxes below to agree to the terms of the program:

After submitting your information, you will be receiving an email from the program coordinator within two weeks. At that time, group scheduling options will be sent via email. The fall program will run from the weekend of April 29 - June 17, 2017 .

Kyle Dine
Program Coordinator
Food Allergy Canada
kdine.anaphylaxis@gmail.com

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