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Plan 10 Registration+2011

This document is a registration form for Planning 10 Summer Session 2011. It requests information such as the student's name, address, phone number, email, school details, parent/guardian contact information, and signature. The form provides instructions to print information neatly and includes the school's address, phone number, fax, email and website for reference.

Uploaded by

Chas Ko
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© Attribution Non-Commercial (BY-NC)
We take content rights seriously. If you suspect this is your content, claim it here.
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40 views1 page

Plan 10 Registration+2011

This document is a registration form for Planning 10 Summer Session 2011. It requests information such as the student's name, address, phone number, email, school details, parent/guardian contact information, and signature. The form provides instructions to print information neatly and includes the school's address, phone number, fax, email and website for reference.

Uploaded by

Chas Ko
Copyright
© Attribution Non-Commercial (BY-NC)
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PDF, TXT or read online on Scribd
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5310 Woodsworth Street, Burnaby, B.C.

V5G 1S4
Telephone: (604)664-2526 Toll free 1-888-479-8882 Fax: (604)664-2527
http://online.sd41.bc.ca Email: [email protected]

Planning 10 Summer Session 2011 Registration

Please print information neatly.


SCHOOL INFORMATION
1 Registration Date: ____/_____/______ Personal Education Number (PEN) Graduated: Yes No
Day Month Year If Yes, Upgrade required:
2 Current School or Last School Attended New Student or Returning Student Last Grade completed:
School Name School Phone School Fax

School Address City Postal Code

STUDENT INFORMATION
3 Legal Last Name First Name Middle Name(s)
Name
Preferred Last Name(if different) First Name(if different) Middle Name(s)
Name

Date of Birth Gender First Nations Ancestry?


____/_____/______ Canadian Citizen Other
Day Month Year F M Yes No Landed Immigrant Specify _______________
Home Address City Postal Code

Home Phone Cell Phone Student Email Address (please print neatly)
(Hotmail users, please check your Spam folder)

Do you have an alternate email address? If yes, please print here:

PARENT/GUARDIAN INFORMATION
4 (Circle One) Last Name First Name
Mr. Mrs. Miss Ms.
Relationship to Student: Address (if different from student)

Home Phone Work Phone Cell Phone Parent Email Address (print)

(Hotmail users, please check your Spam folder)

Parent/Guardian signature: _X__________________________________ Date:


_____________________

Planning 10 Summer Session Registration Form


Revised 4/1/2011

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