514.808.9053
info@collectivevision.ca

Workshop Registration

PARENT / GUARDIAN INFORMATION

Parent First & Last name (required)

Your Email (required)

Confirm e-mail (required)

Street Address (required)

City (required)

Province (required)

Postal Code (required)

Home Telephone (required)

Work Telephone (required* Please write NO for none* )

Cellular (required* Please write NO for none* )

EMERGENCY CONTACT

Emergency Contact Name (required)

Relationship (required)

Emergency Contact Telephone 1 (required)

Emergency Contact Telephone 2 (required* Please write NO for none* )

ATTENDEES INFO

Child's First & Last name (required)

Age (required)

Medicare , In-case of emergency (required)

Any allergies or medical conditions we should know about? (specify) * Please write NO for none* (required)

Please select your method of payment

Children will participate in all the activities listed below, we surveying interest in the following topics to better structure the content of the lessons.

First Interest

Second Interest

Third Interest

TERMS AND CONDITIONS

I give permission to the animators of Creative Video to make any decisions regarding the well being of my child(ren). I give permission for my child(ren) to go to the park with the group. I will not hold Coop Collective Vision/Creative Video, or Concordia University responsible for any injuries or for any and all claims of loss and damage to property that may occur. I agree to allow Coop Collective Vision/Creative Video to use all pictures and videos across all media platforms, present and future. A registration must be accompanied by a full payment. I understand that there is a 50% cancellation fee which will not be refunded for any reason (ie. illness, change of plans, etc.).

Do you agree to the terms and conditions?

How did you hear about us? PLEASE be as specific as possible (required)