After School Program Taekwondo & Homework

1. After School ProgramTaekwondo & Homework Seong’s Taekwondo World Oakville 461 North Service Rd. W. #43 (905)510-3434 Seong’s Taekwondo World Mississauga 1055 Canadian Place #105 (905)625-9696

2. A+ After School Program • Free Pick Up from School • Daily Taekwondo Classes • Supervised Homework Time • Reading & Tutoring • Snack Time • Game & Activities • School Dismissal to 6:00pm

3. After School Program Registration Child Name : _____________________________ Age : ____________ DOB : _____/_____/________ M / F Home Address : _________________________________________________________________________________ City : ____________________________ Province : ________ Postal Code : ___________________________ Phone # : _________________________________ Cell # : _________________________________ Health Card # : ______________________________________ Allergies : ________________________________ Special Needs : __________________________________________________________________________________ School Information School Name : _________________________________________Grade : _________________ Address : _________________________________________________________________________________________ City : __________________________ Phone # : __________________________ Dismissal Time : _________________ Parental Information (Emergency Contact) Name : (Mother)_____________________________________(Father)_____________________________________ • Home Address (If Different from above) : _______________________________________________________ • City : ____________________________ Province : ________ Postal Code : ___________________________ • Phone # : _______________________ Work Phone # : _______________________ Cell # : ______________________ In registering my child to attend Master Seong’s Taekwondo World program. I undersigned parent, guardian hereby agree as follow ; • To permit my child to participate in the full range of activities • I agree to let my child go to supervised excursions outside the Taekwondo World Facility • I understand that photographs and/or video taken during the programs may be used in promotional material • I hereby consent to such use by Taekwondo World • Print Name : ______________________________________ • Signature : ___________________________________________ Date : ___________________________________________