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
Please Select
1st
2nd
3rd
4th
5th
6th
7th
8th
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
Please Select
Both Parents
Mother Only
Father Only
Guardian
Other
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.
Format: (000) 000-0000.
Business Phone Number
Please enter a valid phone number.
Format: (000) 000-0000.
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.
Format: (000) 000-0000.
Business Phone Number
Please enter a valid phone number.
Format: (000) 000-0000.
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.
Format: (000) 000-0000.
Business Phone
Please enter a valid phone number.
Format: (000) 000-0000.
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
Guardian Name
First Name
Last Name
Signature
Submit
Should be Empty: