Niagara Health Little Doctor Registration

This form is for our NEW 8 week Little Doctor programs held in partnership with Niagara Health at Marotta Family Hospital 1200 Fourth Ave St. Catharines. Classes run every Thursday evening from October 1 - November 19.

Parent Name*
First Last
Email*
Phone Number*
Child's Name*
First Last
Child's age*
Does your child have any allergies? If so, please describe
Select a Program
Niagara Health Programs
- Little Doctor 4:30pm - 5:30pm
- Sports Medicine 6:00pm - 7:00pm
October 1 - November 19, 2026
I give consent to have photographs and/or video taken of my child during class sessions & be posted on Social Media*
- Yes
- NO
Waiver Form*
- I have read and agree to the Parental waiver below for my child.
This agreement releases Little Medical School Niagara, it's employees and/or independent contractors from all liability relating to any injuries that may occur to my child/children, however caused, arising out of or in connection with their taking part in any of the Little Medical School classes, instructions, camps, birthday parties or any programs offered. I also acknowledge the risks there may be with the use of medical instruments as part of the instruction, and that my child may bring home. These include but are not limited to stethoscopes, BP cuffs and reflex hammers. Additionally, my child does not have any conditions that will increase their likelihood of experiencing injuries while engaging in the activities. By consenting to this agreement, I agree to hold Little Medical School, entirely free from any liability for any reason, and that all risks are clear to me.
Signature
Promo Code
How do you want to pay*
- PayPal
- e-Transfer
Processing Fee
Price:
PayPal Processing Fee
Total
$ 0.00 CAD
Please make payment via INTERAC e-Transfer to: niagara@littlemedicalschool.com
Input your e-transfer confirmation number in the box below. Click submit to finalize the registration.
Payment Method

MasterCard
Visa
Supported Credit Cards: MasterCard, Visa
Card Number Expiration Date Security Code Cardholder Name
e-Transfer Confirmation*
Please note: Your registration is complete only upon receipt of payment. Class Cancellation Disclaimer: Please note that all classes are subject to a minimum enrollment requirement. If we do not receive enough student registrations or there is a venue cancellation, the class will not be held. We will notify you in advance and may give you an alternate option, if not we will provide full refunds if a class is canceled due to insufficient enrollment or lack of venue. There will not be refunds for parent/guardian cancellation with less than 3 days notice, a credit will be offered. Thank you for your understanding.
Credit Card

American Express
Discover
MasterCard
Visa
Supported Credit Cards: American Express, Discover, MasterCard, Visa
Card Number Expiration Date Security Code Cardholder Name
Please note: Your registration is complete only upon receipt of payment. Class Cancellation Disclaimer: Please note that all classes are subject to a minimum enrollment requirement. If we do not receive enough student registrations or there is a venue cancellation, the class will not be held. We will notify you in advance and may give you an alternate option, if not we will provide full refunds if a class is canceled due to insufficient enrollment or lack of venue. There will not be refunds for parent/guardian cancellation with less than 3 days notice, a credit will be offered. Thank you for your understanding.
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Select a Program