Required fields are marked with asterisks (*)

Welcome to the EarlyON Participation Form

We are so pleased you will be joining us.

All families are required to complete a new participation form before attending in-person or virtual programs. After your form is submitted, you will receive a family code. This form only needs to be completed once per household. If your child will be attending program with someone other than yourself or your partner/spouse (for example: grandparent, caregiver, family friend, etc.), the other adult will need to complete a separate form.

If you have any questions regarding this form, please contact Roberta Snoddon at roberta.snoddon@muskoka.on.ca.

This information is collected in a safe and secure manner and is collected in accordance with s.29(2) of the Municipal Freedom of Information and Protection of Privacy Act

First Name:

Last Name:

Postal Code:

Phone Number:

Email address:

Spouse/Partner name (first and last), if applicable:

In case of an emergency, who should be contacted? (other than yourself)

Emergency Contact Phone Number:

Please tell us about the children that normally attend programs with you:

Child 1 Name (first and last):

Child's Birth Date:

Your relationship to the child:

Parent

Grandparent

Child Care Provider

Other

Is there a second child who attends programs?

Yes

How did you learn about EarlyON Programs?

Previously Attended

Friends/Family

Facebook

Website

Other

Form Builder

Welcome to the EarlyON Participation Form

Please tell us about the children that normally attend programs with you: