Middle School Enrollment Form
Student Information
Name
First Name Last Name
Date of Birth
Month Day Year
Date
Gender
Male Female Prefer Not to Say
Grade
Siblings at this School
Yes No
Siblings Name
First Name Last Name
Address
Street Address
Street Address Line 2
City State / Province
Postal / Zip Code
Citizenship
Ex: Canadian
Language Spoken at Home
Ex: English
Living With
Guardian Information
Guardian-1 Name
First Name Last Name
Relationship to Student
Ex: Mother
Gender
Male Female Prefer Not to Say
Email
example@example.com
Home Phone Number
Please enter a valid phone number.
Business Phone Number
Please enter a valid phone number.
Address
Street Address
Street Address Line 2
City State / Province
Postal / Zip Code
Guardian-2 Name
First Name Last Name
Relationship to Student
Ex: Mother
Gender
Male Female Prefer Not to Say
Email
example@example.com
Home Phone Number
Please enter a valid phone number.
Business Phone Number
Please enter a valid phone number.
Address
Street Address
Street Address Line 2
City State / Province
Postal / Zip Code
Emergency Contact Information
Name
First Name Last Name
Relationship to Student
Home Phone
Please enter a valid phone number.
Business Phone
Please enter a valid phone number.
Educational Background
Previous School Attended
Ex: Kings College P.S.C
School Address
Street Address
Street Address Line 2
City State / Province
Postal / Zip Code
Last Grade Attended
Ex: 3rd Grade
First Entry to Elementary School
Month Day Year
Date
Transfer Reason
Date
Month Day Year
Date
Documentation Verified By
First Name Last Name
Signature
Clear
Guardian Name
First Name Last Name
Signature
Clear
Should be Empty: