Italian Sessions Registration

General Information
Is this a gift?*
- Yes
- No
Name*
First Name Last Name
Child Last Name*
Child First Name*
Child Date Of Birth*
DD slash MM slash YYYY
Child Gender*
- Male
- Female
Parent Last Name*
Parent First Name*
Address*
Address 1 Address 2 City Province Postal Code
Home Phone Number*
Cell Phone Number*
Parent Email Address*
How did you hear about us?*
Other*
Location*
Age*
10:00 am - 12:00 pm
$300 / 10 2-Hour Sessions
Klein House
1:00 pm - 3:00 pm
$300 / 10 2-Hour Sessions
Klein House
10:00 am - 12:00 pm
$300 / 10 2-Hour Sessions
Humber Valley United Church
1:00 pm - 3:00 pm
$300 / 10 2-Hour Sessions
Humber Valley United Church
Sub Total
Price: $ 0.00 CAD
HST
Price: $ 0.00 CAD
Total
$ 0.00 CAD
Credit Card*

American Express
MasterCard
Visa
Supported Credit Cards: American Express, MasterCard, Visa
Card Number Expiration Date Security Code Cardholder Name
Terms and Conditions*
- I accept Italo Bambini Italian Camp Inc. Terms and Conditions
Certify All Information*
- By entering my child's information, I acknowledge and certify all information

^* indicates the required field

ITALO BAMBINI