Keyboarding for Kids Program Registration

Keyboarding for Kids 2012-2013 Application Form

Please complete the below form to register for the Keyboarding for Kids program. A separate form must be submitted if you are registering more than one child.

Step 1 of 3

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Child's Name*
FirstLast
Date of Birth*
Age*
Address*
Street AddressAddress Line 2CityState / Province / RegionZip / Postal CodeCountry
Parents' Name*
Home Phone*
Work Phone (Mother)
Work Phone (Father)
Cell Phone
Email*
School attending in September?*
Emergency Contact*
FirstLast
Relation to Child*
Emergency Contact Number*

Please complete:
Tell us a little bit about your child's attitude toward computers and keyboarding.*
How would you best describe your child's current keyboarding ability?*
What goals/areas would you like to see worked on?*
Does your child have a learning disability or ADHD? If so, please describe.*
Has your child attended any other keyboarding programs? (please specify)*
Please exclude any LDATD programs
Additional comments

Participation
Only 15 participants per group. Groups meet on Saturdays at the LDATD office, 121 Willowdale Ave., suite 203
Please choose a session date
- Apr. 28 - Jun. 9
- Sept. 15 - Oct. 27
- Nov. 3 - Dec. 15
- Jan. 12 - Feb. 23
- Mar. 2 - Apr. 20
- Apr. 27 - Jun. 8
- Package of 5 sessions
Please choose a session time*
- Group 1 - 10:00am - 11:15am
- Group 2 - 11:30am - 12:45pm
Total
$ 0.00 CAD
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Keyboarding for Kids Program Registration

Keyboarding for Kids 2012-2013 Application Form

Step 1 of 3

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