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Registration request for Simple Snacking


Thank you for your interest in this event/program. Please complete and submit the form below.


Timeslot:
Tuesday 6th Dec 2022, 5:00pm - 7:00pm
Location:
FHT Office
Availability:
14 spaces remaining



Name:
Date of Birth:
Parent/Guardian:
OHIP #:
Email:
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Phone Number:
 
Address Line 1:
Address Line 2:
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Physician:
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1. All your information is treated confidentially.

2. If you are registering on behalf of someone else (e.g. dependent, child), please enter the date of birth and health card of that person.