Registration Langley Camps Classes Application Courage 4 Kidz Do you have any questions? Call: (778) 913-8341 Email: info@courage4kidz.com Title Please Select Mr Mrs Ms Miss Dr Address Line1 Parent First Name Address Line 2 (Optional) Parent Last Name City Parent Cell Telephone Parent Landline Telephone (Optional) Province Postal Code Parent Email Relationship to Student Please Select Mother Father Grandmother Grandfather Brother Sister Aunt Uncle Foster Parent Foster Carer Step Mother Step Father Social Worker House Keeper Other Emergency First Name Emergency Last Name Emergency Telephone Number Student First Name Student Last Name Student Date of Birth Which Academic School does he/she attend? Student Gender Please Select Male Female Allergies, Medical Issues; or Anything else we need to know? Please Select The Price. Note: For More Details Please See Our Camps Page CREATIVE MUSIC EXPRESS (HALF DAY, 9:00am - 12:00pm) / 3 (hrs): $120.00 (July 4th -7th, 4 days only) CREATIVE MUSIC EXPRESS (HALF DAY, 9:00am - 12:00pm) / 3 (hrs): $150.00 COURAGE 4 KIDZ SPECIAL (FULL DAY, 9:00am - 5:30pm) / 8.5 (hrs): $240.00 COURAGE 4 KIDZ SPECIAL (FULL DAY, 9:00am - 5:30pm) / 8.5 (hrs): $300.00 How did you hear about us? Please Select Gathering Facebook Google Search I'm currently attending Previously Attended Roadside Banner School Word of mouth Agree to Terms and Conditions Click here to agree with our term and conditions and declaration to participate. I declare that the information in this application is correct and hereby and hereby apply for a place for my child at Courage 4 Kidz. I understand that Courage 4 Kidz has the right to restrict admission at its own discretion. I understand that my child's place is not secured until a deposit has been received and the Principal has confirmed the place. SEND APPLICATION / $50 PAY DEPOSIT