PSII Learner Registration Request Form
Please fill out this online form to be considered for registration at the Pacific School of Innovation and Inquiry for the 2018-2019 school year.
Learner Last Name (legal) *
Your answer
Learner Preferred Last Name (if different from above)
Your answer
Learner First Name (legal) *
Your answer
Learner Preferred First Name (if different from above)
Your answer
Learner Middle Name(s) (legal)
Your answer
Learner Date of Birth *
MM
/
DD
/
YYYY
Are you of aboriginal ancestry?
Are you normally resident in BC? *
Street Address *
Your answer
City/Town/Village *
Your answer
Province *
Your answer
Postal Code *
Your answer
Learner Phone (optional)
Your answer
Learner E-mail Address (optional)
Your answer
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