Student Information
Your Full Name Male Female Date of Birth Your Address (Street name, city, province, country, postal code) Phone Number O.H.I.P - Health Card Number Medical Condition (allergies, illness, medication, EpiPen) Yes No Yes No If yes, please provide their names and their grades Mother Tongue Language(s) spoken at home
STUDENT STATUS
Canadian Citizen Permanent Citizen Landed Immigrant Refugee Embassy Other
IF THE COUNTRY OF BIRTH IS NOT CANADA, PLEASE COMPLETE THE SECTION BELOW
Country of Birth Date of arrival in Canada
SCHOOLING
Total years spent in school (Fill in the space below by starting with the last school attended) Comments
PARENT AND/OR LEGAL GUARDIAN INFORMATION ONLY
FIRST PARENT AND/OR GUARDIAN INFORMATION
Full Name of the parent Male Female Father Mother Parent Step Parent Foster Parent Legal Guardian Yes No 1 2 3 Home Phone Number Cell Phone Number Office Phone Number Email Address Occupation Yes No If no, please provide your full address below (Street name, city, province, country, postal code)
SECOND PARENT AND/OR GUARDIAN INFORMATION
Full Name of the parent Male Female Father Mother Parent Step Parent Foster Parent Legal Guardian Yes No 1 2 3 Home Phone Number Cell Phone Number Office Phone Number Email Address Occupation Yes No If no, please provide your full address below (Street name, city, province, country, postal code)
IF YOU WANT TO INCLUDE ANOTHER RELATIVE AND/OR GUARDIAN INFORMATION, PLEASE FILL THEIR INFO BELOW
Full Name Male Female Father Mother Parent Step Parent Foster Parent Legal Guardian Yes No 1 2 3 Home Phone Number Cell Phone Number Office Phone Number Email Address Occupation Yes No If no, please provide your full address below (Street name, city, province, country, postal code)
