Jazzercise

To be eligible for any programs provided and supported by the LDSA the family must fall into the catchment area of service that the LDSA presently covers and the child must have Down Syndrome. The cost of the program for parents is 50% of the total cost, with the LDSA subsidizing the remaining 50% of the program. Payment is due at the time of registration. For alternate payment options or any other enquiries, please contact [email protected].

Participant Name *

Participant Guardians Name *

Participant Age *

Participant Address *

City *

Province *

Postal Code *

Participant Phone Number *

Participant Email Address *

Guardian Email Address *

Participant Emergency Contact Phone Number *

I consent to allow photos of the participant to be used by the LDSA for advertising purposes such as social media or on our website. *

Payment Details

Jazzercise SessionsJanuary SessionsFebruary SessionsMarch SessionsApril Sessions

Total

$

Credit / Debit Card *

Jazzercise Program Registration

Payment Details

London Down Syndrome Association

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