EVERGREEN STEAM ACADEMY REGISTRATION FORM

EVERGREEN ACADEMY

NOT FOR PROFIT PRIVATE SCHOOL 5100 Appleby Line, Burlington, ON.
Student Information:
Full Name Of Student*

First NameMiddle NameLast Name
Date Of Birth:

MonthDayYear
Date
MaleFemale
Address*

Street Address

Street Address Line 2

CityProvince

Postal CodeCountry
Phone Number*

Area CodePhone Number
Student's previous school:
Student OEN (Ontario Education Number)
Medical Information (Please list any allergies or medical conditions)
Behavioral Information
Parent #1 information :
Full Name
Phone Number
Email*
example@example.com
Lives with Student
Address (If different from student)
Parent #2 information :
Full Name
Phone Number
Email*
example@example.com
Lives with Student
Address (If different from student)
Emergency Contact Information
First Name Last Name Street Address City Province Postal Code Phone Number
Relationship to Student:
OUR PROGRAMS

FULL TIME PROGRAM ($1270.50.00/monthly includes early drop off if needed. 7:30am - 8:50am drop off, 9am - 3:30pm instructional day)PART - TIME 2 DAY (only available for JK/SK students) ($793/monthly)PART TIME 3 DAY (only available for JK-SK students) ($1157.50/monthly)FOOD PROGRAM ($325/monthly, includes 2 healthy snacks and a healthy lunch)FOOD PROGRAM FOR PART - TIME STUDENTS ($132/ monthly for 2 DAY program)FOOD PROGRAM FOR PART - TIME STUDENTS ($198/monthly for 3 DAY program)AFTERSCHOOL PROGRAM ($350/monthly, 3:30PM - 6:00PM)
There is a one-time, non-refundable registration fee of $250. Additionally, to secure your child’s spot, a deposit covering both the first and last month’s tuition is required.
How did you hear about us?
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Once you submit your form please send the one time $250 registration fee to halton@evergreenlearning.ca

All pre-paid fees are non-refundable.
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EVERGREEN ACADEMY

Student Information:

Emergency Contact Information