Enrollment Application

Join the Mini Explorers family today!

Program

Preferred Start Date

Child's First Name

Child's Last Name

Child's Date of Birth

Child's Gender

Parent/Guardian First Name

Parent/Guardian Last Name

Email Address

Phone Number

Address Line 1

Address Line 2 (Optional)

City

Province/State

Postal Code

Emergency Contact Name

Emergency Contact Phone

Relationship to Child

Medical Conditions (if any)

Allergies (if any)

Medications (if any)

Special Needs or Dietary Requirements

Additional Comments or Questions

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