Trial Request Form

*Student's Name

*Date of Birth *Age

*Gender

Male

Female

*Address

*City

*Province

*Postal Code

*Country

*Phone Number

*Email

*Emergency Contact

Select your Program:

*Program:

*Program Select:

*Trial Day:

*Time Preference:

If other program please specify:

Educational Background:

Name of School:

How did you hear about Thinnox? Other Source:

*Location

By clicking Submit I hereby certify that the information I have provided is accurate and complete. I also certify that I understand Thinnox's payment options, cancellation & camp rules (YOU MUST BE 18 YRS OR OLDER, OR A PARENT/GUARDIAN TO SUBMIT THIS FORM.)