REGISTRATION

The annual fee of $25 covers the fieldhouse and toy rental. Please make cheques payable to Open Door Society Playgroup or ODS and bring to the playgroup with info below filled out.

Parent Name: _______________________________

Parent Name: _______________________________

Child’s Name: ___________________ Birth Date: _______________

Country adopted from:  _____________________

Child’s Name: ___________________ Birth Date:_______________

Country adopted from:  _____________________

Address: _________________________________

City:_________________________  Postal Code: _______________

Telephone:____________________

E-mail Address:  _____________________________

I acknowledge the information provided will be listed in the ODS Playgroup Member list which may, from time to time, be distributed to the active members of the ODS Playgroup.

 Signature:  _____________________________