Student Registration Form

STUDENT REGISTRATION

I am registering for: (choose one)

Course Date

Last Name

First Name

Middle Name

Address

City, Province

Postal Code

Mobile Phone Number

Email Address

Date of Birth

Gender

Citizenship

Proof of Citizenship (Birth Certificate, Passport, Status Card)

Current Government ID (Driver's licence, Provincial ID Card, Health Card, Firearm Licence, etc)

Photo (please attach a passport quality photo of yourself that has been taken within the last 3 months)

Have you ever been charged and/or convicted of a criminal offence?

Yes No

If yes, attach a Statement and/or Certified Criminal Record Check

Method of Payment (choose one and enter details below)

Business/Community Name

Address including Postal Code

Contact Person

Contact Phone

Contact Email

Your response to these questions is voluntary. All responses are confidential and are protected under the Privacy Act.

I understand

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