School Registration

School Registration Form

*School Name:

*Address:

*City:

*Postal Code:

*Phone:

Fax:

*Contact Name:

*Email:

Name of dentist requested:

Please indicate the number of classes and students in each grade that you would like to participate in Brush-a-mania:

Junior Kindergarden

Classes:

Students:

Senior Kindergarden

Classes:

Students:

Grade 1

Classes:

Students:

Grade 2

Classes:

Students:

Grade 3

Classes:

Students:

Grade 4

Classes:

Students:

Grade 5

Classes:

Students:

Grade 6

Classes:

Students:

Grade 7

Classes:

Students:

Grade 8

Classes:

Students:

(Your assigned dentist will contact you to arrange a convenient date and time.)

For more information, contact Annie Chouljian: annie.chouljian@tdsb.on.ca

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