Birthday Parties : Ready For Takeoff

Identification * Required Information
Participant's Name:*
Gender:*	Male Female
Date of Birth:*
Parent/Guardian's Name:*
Contact Information * Required Information
Address 1:*
Address 2:
City:*
Prov/State:*
Country:*
Postal code/Zip:*
Telephone (Home): *	( )
Telephone (Work):	( ) Ext.:
Telephone (Cell):	( )
Best Time to Call:	(between 8:30 a.m. and 3:30 p.m. EST)
Fax:	( )
E-mail:
Are you a Member?: *	Yes No
Program Information * Required Information
Language:*	English Français
Date of Visit * Required Information This program is offered on Saturdays and Sundays from 1 p.m. to 3 p.m.
Date:*
Group Information * Required Information
Number of Participants:*	Max. 12
Number of Chaperones:*	Max. 5 per group

Identification