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, scheduling options will be sent via email. The fall program will run from the weekend of September 30 - November 25 2017 .

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

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