registration form

Please enable JavaScript in your browser to complete this form.

I. Demographic Data

His Name

First

Last

Her Name

First

Last

Address

Address Line 1

Address Line 2

City

State / Province / Region

Postal Code

Country

Home Phone

(optional)

His Cell

His Email

His Profession

His Birthday

Wedding Anniversary

If Common-law, how many years?

Her Cell

Her Email

Her Profession

Her Birthday

Name of Child 1

Age of Child 1

Child 1 Single/Married

Name of Child 2

Age of Child 2

Child 2 Single/Married

Name of Child 3

Age of Child 3

Child 3 Single/Married

Name of Child 4

Age of Child 4

Child 4 Single/Married

Number of Grandchildren

II. Sponsor Data
(Only if you have a sponsor)

His Name

His Phone

Her Name

Her Phone

Email(s)

How do you know your sponsors?

III. Information for the weekend

a) Wheelchair/Accessibility Required

His Allergies

Her Allergies

c) Any Additional Allergy Comments:

Emergency Contact(s):

Name

Phone

IV. What do you expect from this weekend?

V. Comments or Questions?