Please submit one form per child.

Personal Information

Participant  

Child's First Name

Child's Last Name
Birth Date: (ex. January 1, 2015)
Age
Gender: Male Female  
School
Grade

Home Address

City

Province
Postal Code
Home Phone
 
Does your child have any allergies?
(please list)
 
Does your child take any medications?
(please list and explain)
 
Parents  
Mother's Name
Mother's Cell Phone
Mother's Email Address
Father's Name
Father's Cell Phone
Father's Email Address
Siblings
Name of Sibling with Special Needs
Age of Sibling with Special Needs
Name or description of disability or health concern
Other Siblings' Names and Ages

Sibshops Dates and Fees
Sibshops of Ottawa will take place at the Dovercourt Recreation Centre, 411 Dovercourt Ave. from 10:00 am - 12:00 pm, unless otherwise stated.
Location and dates are subject to change with notice. (Fees include snacks)

Please Note: Registration Fees are Non-Refundable

All Sibshops

All 12 Sibshops in 2016 $140

Individual Sibshops

Sunday, January 24, 2016 $15
Sunday, February 21, 2016 $15
Sunday, March 20, 2016 $15
Sunday, April 17, 2016 $15
Sunday, May 22, 2016 $15
Sunday, June 19, 2016 $15
Sunday, July 17, 2016 $15
Sunday, August 21, 2016 $15
Sunday, September 11, 2016 $15
Sunday, October 16, 2016 $15
Sunday, November 13, 2016 $15
Sunday, December 4, 2016 $15

Scholarship Information

Scholarships are available for families in need of them.
No child will be refused due to lack of funds.

Yes, I'd like my child to be considered for a Sibshop Scholarship.

Is there anything you'd like us to know in regards to this Scholarship request?

Donation Information

All sponsor a child and general donations made to Sibshops of Ottawa will receive an official tax receipt.

Yes, I would like to sponsor Sibshop Child(ren) - ($120/child)
Sponsor a Child Amount:
 
Yes, I would like to make a general donation to Sibshops of Ottawa
Donation Amount:

Payment Information
Please Note: We are unable to accept Visa Debit Cards.

For Scholarship Requests only:
Please write "scholarship" in the 'Total Payment' area and provide valid credit card information. The payment will be processed once you are notified of the scholarship amount and agree to it.

Total Payment:
(Sibshops Registration + any Donation)
 
Visa MC Amex  
 Credit Card Number:  
Credit Card Expiry Date:  
Name on Credit Card:  
Security Code:  

Comments (anything else we should know):