Home Alone Course Registration Form - Municipality of South Bruce

Required fields are marked with asterisks (*)

Welcome

Thank you for your interest in the Home Alone Course offered by St. John Ambulance. This comprehensive course will provide essential skills for home safety. Participants will be given a half hour lunch break, and must remain onsite during this time unless accompanied by a parent/guardian.

Registration is on a first come-first serve basis, using this form.

Once the form has been submitted a staff member will confirm your registration. You will then receive an invoice with instructions on how to submit payment.

Parent/Guardian Full Name:

Name of Participating Child:

Participating Child Date of Birth:

Participating Child Current Age:

Allergies or Food Sensitivities:

Does the participating child require any support to enhance their learning experience throughout the course? Please note that there will be a quiz at the end of the course.

Do you consent to having pictures of your child taken while at program?

Yes

Home Address: (Please include your PO Box if applicable as course certifications will be mailed)

Email Address:

Phone Number:

I understand that there is a fee of $75.00 to participate in the Home Alone Course.

I Understand and Agree

Would you like to purchase a babysitting kit?

Do you consent to the Municipality of South Bruce sharing this information with St. John Ambulance staff as they are conducting the course? St. John Ambulance staff may contact you prior to the course date.

I Consent

Forms

Welcome