Penelakut Island Learning Centre. Photo courtesy of Vancouverisland.com Please enable JavaScript in your browser to complete this form.Start DateName *FirstMiddleLastPhone PENPersonal Education NumberEmailStreet Address, City, Province, Postal Code *Date of Birth: Month/Day/Year *Grade *Grade 10Grade 11Grade 12Grade 12 AdultGraduated AdultSecondary UngradedIf you are over 18 and have not graduated select Grade 12 AdultAboriginal Ancestry *Status on reserveStatus off reserveNon-Status on reserveMetisInuitStatus Card Number *Band Name *Care Card NumberEmergency Contact and Contact Phone NumberDo you have any life threatening or known medical issues that we should be aware of? *YesNoExample: AnaphylaxisIf yes please describe:Where did you attend school last? What year or grade did you complete?I understand that by completing this form I am tentatively registered until I sign a consent form and confirm identification with one piece of photo ID. *YesNoStudents under the age of 18 must have a parent or legal guardian come in to sign consent form. EmailSubmit