* First Name
* Last Name
* Grade -- Please Select Grade -- Grade 1 Grade 2 Grade 3 Grade 4 Grade 5 Grade 6 Grade 7 Grade 8
* Gender Male Female

* Family Name
* Address
* City
* Postal Code
* Home Phone #
* E-Mail Address

   Name
   Work #
   Cell #

   Name
   Work #
   Cell #

* Name
* Number
   Relationship

   Allergies
   Additional Info

* Walk Home Yes No
   Picked up by

* Location Blue Willow
* Program -- Please Select Program -- August 3 - 6 - $240 Full Day August 3 - 6 - $120 Half Day August 9 - 13 - $300 Full Day August 9 - 13 - $150 Half Day August 16 - 20 - $300 Full Day August 16 - 20 - $150 Half Day

iCompute Learning Centre Inc. reserves the right to cancel workshops for reasons including, but not limited to low enrollment.  Students who have had their workshop canceled by iCompute will be placed into another available workshop, or have a complete refund of their fees.

1. Our fees are for a personal reservation for a specific period and not a day by day fee. We therefore will not refund fees for days missed for any reason.

2. iCompute Learning Centre Inc. reserves the right to terminate registration of any student if, in the opinion of the staff, it is in the best interest of the child or the other students. In such event, a proportional refund will be made.

3. The Parent or Guardian hereby consents to the use by iCompute Learning Centre Inc. of the student’s photograph or video image for publicity purposes.

By typing my name in the Parent Signature box below I / We have read, understand and agree with the Conditions of Enrollment detailed above. Please enroll my child(s) as named herein at iCompute Learning Centre Inc. according to the program choices selected in the registration sections of this Application for Enrollment.

   Signature
   Date