Registration

_{Penelakut Island Learning Centre. Photo courtesy of Vancouverisland.com}

Start Date

Name *

First

Middle

Last

Phone

PEN

Personal Education Number

Email

Street Address, City, Province, Postal Code *

Date of Birth: Month/Day/Year *

Grade *

If you are over 18 and have not graduated select Grade 12 Adult

Aboriginal Ancestry *

Status Card Number *

Band Name *

Care Card Number

Emergency Contact and Contact Phone Number

Do you have any life threatening or known medical issues that we should be aware of? *

Yes
No

Example: Anaphylaxis

If 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. *

Yes
No

Students under the age of 18 must have a parent or legal guardian come in to sign consent form.

Website