Participant Registration Information

Payer information

Please tell us who paid for this course.

Payer Name*

First Last

Email*

Phone

Company (if applicable)

For: Adult Courses

Adult Courses (if you are registered for a Children/Youth workshop, please skip this section)

Course

Please select your registered course from the list below.

Participant

Please list the participants registered for your chosen course. Click the symbol (+) to add additional participants. Please enter their email and phone number if possible. If you do not know it, please enter "Unknown".

First Name	Last Name	Email	Phone Number

For: Children & Youth Workshops

(only fill out this section if you are registering for a Children/Youth workshop)

Course

Please select your registered course from the list below.

Participant

Please list the participant(s) registered for your chosen course. Click the symbol (+) to add additional participants.

First Name	Last Name	Age	Grade	Teacher	Home Phone Number

Emergency Contact Numbers

Please list the emergency information for each participants you have listed above in successive order. Click the plus to add additional participants.

Name	Medical Conditions or Concerns	Mother`s cell phone	Father`s cell phone

Following the workshop, the participant will:

Be picked up by parent at school
Return to the after school daycare
Walk home

Parent/Guardian Consent

Please indicate consent for the participation of any minor under 18.

I consent to the participation of the registered participant(s) for this course.

Where did you find out about this course?*

Other*

Ottawa & Eastern Ontario Safety Training

Participant Registration Form

Payer information

For: Adult Courses

For: Children & Youth Workshops

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