Admission Form for New Applicants 2014-15
Please fill all information accurately. Please note, submission of this form does not guarantee admission into the program. See website for detailed registration procedures. All information submitted will be dealt with appropriate confidentiality
Student Information
First Name *
Your answer
Last Name *
Your answer
Date of Birth *
MM
/
DD
/
YYYY
Gender *
Seeking admission in Grade *
Living with *
Home Address
Street Number *
Your answer
Street Name *
Your answer
Postal Code *
A1B 2C3
Your answer
City *
Your answer
Home Phone# *
123-456-7890
Your answer
Parent/ Guardian Information
Father/ Guardian's Name *
Your answer
Cell Phone *
123-456-7890
Your answer
Work Phone *
123-456-7890
Your answer
Your answer
Mother/Guardian's Name: *
Your answer
Cell Phone *
123-456-7890
Your answer
Work Phone (if applicable)
Your answer
Email
Your answer
Emergency Contact Information
Emergency Contact must be separate from Parent/Guardian
Contact Name 1
Your answer
Relation to Child
Your answer
Cell phone
123-456-7890
Your answer
Home Phone
123-456-7890
Your answer
Contact Name 2
Your answer
Relation to Child
Your answer
Cell phone
123-456-7890
Your answer
Home Phone
123-456-7890
Your answer
Medical Information
Does your child suffer from any health conditions or medical concerns *
If yes, please explain:
(please mention all allergies the child has, if any)
Your answer
Other Information
Please mark all that apply to you as a parent *
Required
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