Web Registration Receipt
Date:
05/05/2024
* Mandatory Fields
Your Contact Details
*
First Name:
*
Last name
*
Address
*
City
*
Province
*
Postal Code
*
Email
I DO NOT have an email address
*
Confirm Email
*
Main Phone #
*
Emergency
Contact Name
*
Contact Ph#
Registration: Up to 4 programs on one form. To register for more programs, complete another form
Program
Fee
1
.
Computers
Dance
Education
Fitness
Music-Art
Games
Social
Special Event
(please select)
Time:
to:
Date
:
to :
on
Level:
For :
lessons
Instructor :
2
.
Computers
Dance
Education
Fitness
Music-Art
Games
Social
Special Event
(please select)
Time:
to:
Date
:
to :
on
Level:
Language:
For :
lessons
Location:
Instructor :
3
.
Computers
Dance
Education
Fitness
Music-Art
Games
Social
Special Event
(please select)
Time:
to:
Date
:
to :
on
Level:
For :
lessons
Location:
Instructor :
4.
Computers
Dance
Education
Fitness
Music-Art
Games
Social
Special Event
(please select)
Time:
to:
Date
:
to :
on
Level:
For :
lessons
Location:
Instructor :
Totals
$0.00
The Prov. of Ontario and the City of Toronto subsidizes some program costs for seniors. Please select your age range: are you:
55-59
60-69
70-79
80+
Payment Details
*
Payment
Method
Credit Card
In Person
Postage Mail
If the total is $0.00, select "in-person" and you do not need to come into SPLC
Comments
Missing name / contact details
Age range not selected
No program selected
Payment method not specified
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