International Languages
Elementary
Student Registration Form
Language Program :___________________ Location :

East End
West End
Date of Registration

 :___________________

 

Student Information
First Name :_______________ Last Name :____________
   
Address :_______________ Appt. No. :____________
City :_______________ Province :____________
Postal Code :_______________ Home Telephone :____________
   
Date Of Birth(MM/DD/YY) :_______________ Male / Female :____________
Ontario's Health Card# :_______________ Age :____________

Medical Concerns (if Any):

 
Present School :_______________ Grades in September :____________

Check Board of Education:

O.C.D.S.B O.C.C.S
E.P.E.O C.E.C.L.F Other please Specify

Parent / Guardian's Information
(A) First Name :________________ Last Name :______________
Work Telephone :________________ Home Telephone :______________
(B) First Name :________________ Last Name :______________
Work Telephone :________________ Home Telephone :______________

Emergency Contact
Name :________________ Home Telephone :______________
Signature of Parent/Guardian :________________ Date :______________

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