"Terrific" Toddlers Registration Form

Please print this page, fill it in, and either mail it to PACT with a cheque, or mail it to PACT after paying using the PayPal button for "Terrific" Toddlers. Thank you! If you have any questions, please contact PACT via phone: 403-671-1710 or email: P_A_C_T@hotmail.com.

PACT

12 Hawkridge Place NW Calgary, AB   T3G 3A4

 

 

Program Location:	Brilliant Beginnings - West Hillhurst - 207A - 19th St NW
Program date:    (Please indicate which    course you are    interested in)	4 Saturdays - March 3,10,17,24, 2012 (Dads Course)                  or April 14,21,28 & May 5, 2012 (Regular Course) 1:30-3:30pm
Family Name:	First Name:
Address inc. Postal Code:
Home Phone Number:	Emergency number:                         Email:

 

Conditions of Registration:

·       There is a $25 service charge on all NSF cheques.

·       Full refund will be given 3 days prior to program start.

·       Any concerns regarding the program should be addressed to the Parent Educator.

·       PACT assumes no responsibility for loss, damage, injury, ambulance service or the use of information received.

 

I have read and understood these conditions and accept them as part of my registration.

 

______________________________                                    ______________________________

Participant Signature                                                                Today's Date

 

$135.00 per person ($100 for PACT participants)

$200 per couple

 

Fee Paid: __________ Cheque/Cash/Paypal (circle)                                         Cheques made payable to PACT

 

I heard about the PACT organization from: ________________________

(word of mouth, Calgary's Child magazine, community newsletter, Health Clinic, TV, other?)