On-line School Program Request Form


*	School Name:
*	Teacher Name:
*	Phone Number:	- - ex. 780-444-5555
*	Fax Number:	- - ex. 780-444-5555
*	Email:
*	Mailing Address:
*	Postal Code:	ex. T6T5K5

	Please make sure that you fill out information for at least one program.

*	Program Name 1
*	Grade of Students
*	Request dates
	Choice 1
	Choice 2
	Choice 3
*	Time
*	Number of children
*	Number of adults
*	Special Needs

	Program Name 2
	Grade of Students
	Request dates
	Choice 1
	Choice 2
	Choice 3
	Time
	Number of children
	Number of adults
	Special Needs

	Program Name 3
	Grade of Students
	Request dates
	Choice 1
	Choice 2
	Choice 3
	Time
	Number of children
	Number of adults
	Special Needs

Programs are not confirmed until an official confirmation has been received by the teacher.