To register your child, please fill out the form below. This must be completed for each participating child. Thank you! If you have any questions, please email customers@massajady.com. 

IMPORTANT: If you/your child attended the July Youth MediMorphosis, you must fill out the Follow-Up Survey emailed to you ( or click here ) to be eligible to register for this upcoming Youth MediMorphosis. After filling out the Follow-Up Survey, please return to this survey to register for the September 22nd event.

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* 1. Youth's Full Name ... First Middle (if applicable) Last
(This information will remain anonymous.)

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* 2. Youth's Birthday

  Month Day Year Age of child
Date

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* 3. Youth's Gender

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* 4. Parent/Guardian's Name ... First Last
(This information will remain anonymous.)

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* 5. Parent/Guardian's Email

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* 6. Did your child attend the July Youth MediMorphosis event at LHSC? If so, you must fill out the Follow-Up survey sent to your email (or click here). Completion of the survey and a written or video testimonial is kindly required to attend another Free Youth MediMorphosis

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