Spring Break Visit at The Leaf – Humanitarian Solidarity for Development and Empowerment

Summer Visit For The Youth

Registration Form

Event Details:

Time: 10AM

Participant Information:

Please register for one date and one location only:

July 11at Assiniboine Park Zoo, 2595 Roblin Blvd, Winnipeg, July 18at 145 The Leaf Way, Winnipeg, Manitoba, R3P 2V8

Full Name

Age

Address

City

Postal Code

Phone Number

Email Address

Emergency Contact Name

Emergency Contact Phone Number

Need Transportation

Yes No

Languages speaks

Medical Information:

Parental/Guardian Consent (For Participants Under 18)

I, consent, as the parent/guardian of the above participant, give permission for my child to attend the Spring Break Visit at The Leaf organized by HSDE Canada. I understand that photographs may be taken during the event for promotional purposes, and I grant permission for my child to be included.

Would you like to receive updates about future events from HSDE Canada?

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