Online Registration – Winkler Family Resource Centre

Parents Name (or caregiver that will attend program) *

First

Last

Email *

Email

Confirm Email

Phone *

Is this your first time registering for this program? *

Yes
No

What is the city/town/village you reside in? *

How many children are you registering? *

1
2
3
4

Child #1 Name *

First

Last

Child #1 Birthday *//

If there are any Medical concerns or Allergies, please let us know.

May/June Programs

Laucht unt Liet Friday 9:30-11:00am

Will a younger sibling will be attending program also?

Yes
No

Younger Sibling's Name

First

Last

Sibling's Age

Child #2 Name *

First

Last

Child #2 Birthday *//

Child #2. If there are any Medical concerns or Allergies, please let us know.

May/June Programs

Laucht unt Liet Friday 9:30-11:00am

Will a younger sibling be coming along to the program?

Yes
No

Younger Sibling's Name #2

First

Last

Sibling's Age #2

Child #3 Name *

First

Last

Child #3 Birthday *//

Child #3. If there are any Medical concerns or Allergies, please let us know.

May/June Programs

Laucht unt Liet Friday 9:30-11:00am

Will a younger sibling be coming along to the program?

Yes
No

Sibling's #3 Name

First

Last

Sibling's #3 Age

Child #4 Name *

First

Last

Child #4 Birthday *//

Child #4. If there are any Medical concerns or Allergies, please let us know.

May/June Programs

Laucht unt Liet Friday 9:30-11:00am

Will a younger sibling be coming along to the program?

Yes
No

Sibling's #4 Name

First

Last

Sibling's #4 Age

Photo Consent *

I consent
I do not consent

From time to time WFRC and MPCRC takes pictures for newsletters, our website, funding opportunities and our Facebook Page. Do we have your permission to use photos with your child or children in them?

Session Dates