Student Name
*
First Name
Last Name
Student Registration Form
Student Cell Number
*
-
Area Code
Phone Number
Email
example@example.com
Address
*
Street Address
Street Address Line 2
City
Province
Postal Code
Date of Birth
*
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Month
-
Day
Year
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Attending School
Please Select
Auburn High School
Prince Andrew High School
Cole Harbour High School
Dartmouth High School
Islandview High School
Carrefour School
Halifax West High School
Citadel High School
J.L Ilsley High School
CP Allen High School
Sackville High School
Lockview High School
Millwood High School
Sir John A MacDonald High
Eastern Shore High School
East Hantz Rural High School
Other
Learners License # (If applicable)
Issue Date of License (If applicable)
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Month
-
Day
Year
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How would you prefer to do 25 hours of theory
In person (Over 2 weekends)
Online (At students own pace)
Parent Name
First Name
Last Name
Home Phone or Parent Cell
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Area Code
Phone Number
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