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LDA Child and Youth Registration
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LDA Child and Youth Registration
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Which session(s) are you registering for?
*
Fall (Sept - Dec)
Winter (Jan - March)
Spring (April - June)
Summer (July - Aug)
Child/Youth Name
*
Date of birth (DDMMYYYY)
*
Email Address
*
Home Address
*
City
*
Province
*
--Select--
Alberta
British Columbia
Manitoba
New Brunswick
Newfoundland and Labrador
Nova Scotia
Ontario
Prince Edward Island
Quebec
Saskatchewan
Northwest Territories
Nunavut
Yukon
Postal Code
*
Parent's Name
*
Parent's Daytime Phone
*
Has the applicant been assessed or diagnosed with any of the following?
*
LD
AD(H)D
Anxiety Disorder
Other
None
If you selected "Other" for the above question, please specify what the applicant has been assessed/diagnosed with
Does your child struggle in school?
*
Yes
No
Do you have any concern about your child's learning or behavior development?
*
Yes
No
If so, please describe your concerns
If available, do you require financial assistance?
*
No
Yes
Would you prefer in-person or virtual (if available)
*
In-person
Virtual
Website
Submit
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