1-Please Select Date & Event Type:
2-Your Full Name: 
3-Your Status:
3-Your Status:4-Membership # if applicable:5- Number of attendees per family:
5- Number of attendees per family:6-Your age group: 7-Do you or any family members has Diabetes:
7-Do you or any family members has Diabetes:8-If yes please select one: 9- Have condition since:
9- Have condition since:10-Your current address: Street Number & Name:
City Name:Postal Code:Prov:
Postal Code:Prov: Country:Tel:
Tel: Email address:
11-Have you attended any previous course or seminar before at TBK:
12- If Yes Please specify date and location:
13- Disclaimer:
JDCCI is a Canadian registered charity founded privately by the parents and family members of children with various chronically illnesses specially kids with diabetes. JDCCI is offering these recreational / happy time event at no cost to those families and individuals involve in similar situation to have good time and create awareness,understanding for better control and care for cure. These events are without any obligation and liability at JDCCI or its management/volunteers/professionals and board members. JDCCI will arrange a registered nurse staff memebr and other responsible staff memebrs present on full time basis for its members or participants during these events for safety purposes .JDCCI is not responsible for any out of control incident by personal action of the participant /s during these active events. JDCCi has not authorized any individual to collect any charity or donation without written authority from management which is posted in this website (donation programs link) for these or any other programs.JDCCI reserve the right to accept or reject any application for this event registration with written or verbal explanation to the applicant. JDCCI will not share / keep record of any personal information without consent of the applicant /member.JDCCI will not disclose any personal information to any private or governmental agency without written consent of the applicant or member.
14-I the applicant whose name appears in box 2 of this form have read and understood above disclosure:
Signatures:(Please type your name as appears in box 2 again).
(Please type your name as appears in box 2 again). Please select and click on Submit to sen your registration form:
FREE RECREATIONAL EVENT BY JDCCI REGISTRATION FORM
PLEASE SEND EMAIL BY CLICKING HERE FOR MORE DETAILS ABOUT THESE EVENTS
