Secondary Student Registration Form

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 / Current IEP?

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 *

Course(s) Applying For: Type in the specific name(s) of the course(s) you with to register for, separated by a comma. *

Student Indigenous Ancestry

Are you (the student) from the Sechelt Nation?

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

Signature: Type Name *

SPIDER Elementary (K-6)