ProjectSPIDER Registration

LEGAL Student First Name *

LEGAL Student Family Name *

Personal Education Number (PEN) *

This 9-digit number can be found on a report card or by phoning your school office.

Present School (if applicable)

Who is your current school counsellor?

Special Education Designation?

Student Date of Birth *

Student Home Address *

Address Line 1

Address Line 2

City

State / Province / Region

Postal Code

Country

Student Email *

Student Cell Phone

Parent/Step-Parent/Legal Guardian Name *

First

Last

Parent/Step-Parent/Legal Guardian Cell Phone *

Parent/Step-Parent/Legal Guardian Email *

Student Indigenous Ancestry

Are you (the student) from the Sechelt Nation?

Please provide any relevant details regarding your child's past education

Please provide any relevant information that you think would be pertinent in planning for your child to join ProjectSPIDER (needs/future plans)

I certify that the above information is correct and valid as of: Today's Date *

Signature: Type Name *

SPIDER Elementary (K-6)