Step 1 of 3 33% Date of Event:(Required) MM slash DD slash YYYY Age(Required)Name of Participant:(Required) First Last Address(Required) Street Address Address Line 2 City AlbertaBritish ColumbiaManitobaNew BrunswickNewfoundland and LabradorNorthwest TerritoriesNova ScotiaNunavutOntarioPrince Edward IslandQuebecSaskatchewanYukon Province Postal Code Parent/Guardian:(Required) First Last Relationship to Participant: First Last Phone(Required)Email(Required) If someone other than the above mentioned parent/guardian will be chaperoning please fill out the following questions. Name First Last PhoneEmail Please list any allergies, medical concerns, medication(s) or dietary restrictions.(Required) Emergency Contact Name(Required) First Last Phone(Required)Email(Required) Relationship to Participant:(Required) For payment information and to return this completed registration form please contact Brittany Kelsey, Visitor Services Coordinator at 780-832-1995 or bkelsey@dinomuseum.ca
