Coded Roots Registration

YIHA -Coded Roots

Virtual Coding Class

Registration deadline: March 27th 2025

This registration form will take approximately 10 minutes of your time. If you have any questions or concerns, please call (416-254-3408) or email [email protected].

Intake Information

Name of Parent or Guardian(Required)

First Last

Email(Required)

Phone(Required)

Address(Required)

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Relationship to Child(ren)(Required)

Home Language ( other than English)

Accessibility Needs

Responses do not impact acceptance into the Coded Roots Club. Please provide as much detail as necessary for us to support your child.

Are there any accessibility needs that we should consider for your child(ren) for the Coded Roots (e.g., closed captions, written instructions, patterned visuals for colour-blindness, etc.)

What type of Computer system are you using?(Required)

MAC

Windows

What age range are the children you are registering on their last birthday?(Required)

Age less than 7

Age 7-14

Age greater than 14

How did you hear about ECDI's Coded Roots Club?

Attended a previous ECDI in person Program

Attended previous ECDI virtual Programs

Social Media (e.g., Facebook, Instagram, WhatsApp, etc.)

Community Centre/Library

School

Family/Friends

Religious institution (e.g., church, mosque, etc)

Another Association or Organization

Grocery store/Restaurant

others

Oops! Our program for under 7 and over 14 is coming soon!

Thank you for your interest. Please sign up for ECDI's newsletter for other programs and events at www.ecdinitiative.org

Child 1 Information

Name(Required)

First Last

Date of Birth(Required)

MM slash DD slash YYYY

What grade is your child?(Required)

Gender

Female

Male

Prefer not to say

How old is the child?(Required)

Please enter a number from 7 to 14.

Which Virtual Class would you prefer?

(Please note : While we will work to accommodate your preference this is not a guarantee that your child will be allocated to this class as allocation will be done on a first-come first-served and availability basis)

9-11AM (EST)SATURDAYS (AGES 7-9)

4 - 6 PM (EST) FRIDAYS (AGES 10 -12)

9 - 11 AM (EST) SATURDAYS (AGES 10 - 12)

9-11AM (EST) SATURDAYS (AGES 13-14)(Coming soon!)

Do you have another child to register?(Required)

Yes

Child 2 Information

Name(Required)

First Last

Date of Birth(Required)

MM slash DD slash YYYY

What grade is your child?(Required)

Gender

Female

Male

Prefer not to say

How old is the child?(Required)

Please enter a number from 7 to 14.

Which Virtual Class would you prefer?(Required)

9 - 11 AM (EST) SATURDAYS (AGES 7 - 9)

4 - 6 PM (EST) FRIDAYS (AGES 10 -12)

9 - 11 AM (EST) SATURDAYS (AGES 10 - 12)

9 - 11 AM (EST) SATURDAYS (AGES 13 - 14)(Coming Soon!)

Do you have another child to register?

Yes

Child 3 Information

Name(Required)

First Last

Date of Birth(Required)

MM slash DD slash YYYY

What grade is your child?(Required)

Gender

Female

Male

Prefer not to say

How old is the child?(Required)

Please enter a number from 7 to 14.

Which Virtual Class would you prefer?(Required)

9 - 11 AM (EST) SATURDAYS (AGES 7 - 9)

4 - 6 PM (EST) FRIDAYS (AGES 10 -12)

9 - 11 AM (EST) SATURDAYS (AGES 10 - 12)

9 - 11 AM (EST) SATURDAYS (AGES 13 - 14)(Coming Soon!)

Do you have another child to register?

Yes

Child 4 Information

Name(Required)

First Last

Date of Birth(Required)

MM slash DD slash YYYY

What grade is your child?(Required)

Gender

Female

Male

Prefer not to say

How old is the child?(Required)

Please enter a number from 7 to 14.

Which Virtual Class would you prefer?(Required)

9 - 11 AM (EST) SATURDAYS (AGES 7 - 9)

4 - 6 PM (EST) FRIDAYS (AGES 10 -12)

9 - 11 AM (EST) SATURDAYS (AGES 10 - 12)

9 - 11 AM (EST) SATURDAYS (AGES 13 - 14)(Coming Soon!)

Emergency Contact

Name of Emergency Contact(Required)

First Last

Phone Of Emergency Contact(Required)

Emergency Contact relationship to Child(Required)

Parent/Guardian Consent

Please check the boxes to indicate your consent. If you have any questions or concerns, please contact us by phone (416-254-3408) or by email ([email protected]).

Parental Supervision: By enrolling your child(ren) in ECDI's online coding program, you acknowledge and agree that supervision of your child(ren) during the online sessions remains the responsibility of the parent, guardian, or designated caregiver. ECDI assumes no liability for any incidents that occur while your child(ren) participate in the program from home.

Waiver of Liability: By enrolling my child(ren) in ECDI's online coding program, I agree that ECDI is not responsible for any technical issues or privacy breaches during the program and is not liable for third-party platform issues. I release ECDI from any liability related to my child(ren)’s participation.

Media Release: I hereby grant Early Childhood Development Initiative (ECDI) permission to use the likeness, image, and/or voice of my child(ren) in promotional materials without compensation.

Parent/Guardian Signature:

Today's Date:

I want to sign up to receive ECDI's newsletter and learn more about upcoming programs:
Yes No

How did you hear about ECDI's Coded Roots Club?

Attended a previous ECDI in person Program

Attended previous ECDI virtual Programs

Social Media (e.g., Facebook, Instagram, WhatsApp, etc.)

Community Centre/Library

School

Family/Friends

Religious institution (e.g., church, mosque, etc)

Another Association or Organization

Grocery store/Restaurant

others

Proceed to Payment

Step-by-Step Process for Payment and Form Submission

Step 1: Parent Fills Out the Registration Form
Parents will begin by filling out the required fields in the Registration Form on your website.

Step 2: Parent Clicks the "Proceed to Payment" Button
After completing the registration form, parents will see a "Proceed to Payment" button. This button is clickable and linked to the payment page. Clicking the button will open the payment page in a new tab, allowing the registration form to remain open.

Step 3: Parent Completes Payment
On the Payment Page, parents will select the number of children they are enrolling in each age group. A quantity toggle is provided under each age group option, allowing parents to select the number of children they are registering from 0 to 99.

Ages 7-9: $30/week
Ages 10-12: $35/week
Ages 13-14: $40/week

The total amount for 8 weeks will be automatically calculated based on the number of children selected in each age group. Parents will complete the payment using their preferred payment method (credit card, etc.).

Step 4: Redirected Back to the Form
After the payment is successfully processed, parents will be automatically redirected back to the Registration Form page they were originally filling out.

Step 5: The Form Recognizes Payment Success
Once redirected back, the form will recognize that payment has been completed successfully. A message will appear, or the Submit button will be enabled, signaling that parents can now complete the registration.

Step 6: Parent Clicks Submit to Complete Registration
After being redirected from the payment page, parents will click the Submit button to finalize the form submission. This ensures the child’s registration is completed successfully.

Step 7: Confirmation Message
After submission, a confirmation message will appear, indicating that the child(ren)’s registration has been completed successfully.