EVERGREEN STEAM ACADEMY REGISTRATION FORM

EVERGREEN CHRISTIAN 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
2 digit month, 2 digit day, 4 digit yearDate
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

FILL INFORMATION BELOW
Name

First NameLast Name
Email
example@example.com
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Phone Number

Area CodePhone Number
Relationship to Student:
OUR PROGRAMS
There is a one-time, non-refundable registration fee of $450. 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?
Please verify that you are human
Signature
Once you submit your form please send the one time $450 registration fee to halton@evergreenlearning.ca

All pre-paid fees are non-refundable.
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