Registration form for Masterstroke Atelier Society of Alberta Studio courses
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Name of the Student (first name, middle name and last name)
 *
Father's Name
 *
Mother's Name
 *
Name of emergency contact person
 *
Email of parents or guardian
 *
Alternative email
Email of Emergency contact person
Residential address of the student/parents
 *
Residential address of emergency contact person
 *
Phone Number of parents or guardian
 *
Alternative phone number
Date of Birth
 *
MM
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DD
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YYYY
Start date
MM
/
DD
/
YYYY
Grade level ( Course of preference )
Clear selection
Program of Preference
Clear selection
Method of learning
 *
Convenient Day and time (Mountain time Zone)
 *
Any medical condition of the student that the teacher need to be aware of
Any allergies the student has that the teacher need to be aware of
 
Signature of a parent or guardian (Writing your name here will be considered signature)
Signature for consent form
Clear selection
Date consent form signed
MM
/
DD
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YYYY
Submit
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