Home Alone Registration 2018

Thank you for your interest in the YMCA's Home Alone Course.

November Program Dates:  Monday's:  November 15, 22, and 29th.
Location:  YMCA EarlyON Centre - 161 Roger Street, Waterloo
Time:  6:00-8:00pm

Please complete registration form, upon receipt of your registration form you will receive a conformation email to confirm your child's participation in the course and payment information.

If you have any question please call Beth at 519-741-8585 ext 3006.

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* 1. Child's Name:

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* 2. Date of Birth

Date / Time

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* 3. Parent / Guardian Name

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* 4. Mailing Address / Contact Information

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* 5. Relationship to Participant

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* 6. Alternate Emergency Contact

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* 7. Relationship to Participant

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