STEMVOX Academy Registration

Health and Medical Information

Please fill in the following information carefully.
OHIP Number*
Allergies (Include treatment)
Health History (Diabetes, Epilepsy, Etc.)
Parent and Guardian Information

Please fill in the following information carefully.
Parent Name*

First NameLast Name
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Phone Number*
Please enter a valid phone number.
Email*
example@example.com
Alternative Contact*

First NameLast Name
Relationship to Student*
Phone Number*
Please enter a valid phone number.
Email*
example@example.com

I have read, understood and agree to the policies posted above. I have saved a copy for my records:*

Payment and Refund PoliciesMedical Consent PolicyBehaviour PolicyMedia and Digital Use Policy
Digital Signature and Registration Fee

Parents will be sent an invoice for the registration fee for STEMVOX Academy. Registration is complete and students are enrolled ONLY AFTER the registration fee is received. Registration fees are non-refundable.
Date*
Signature*

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STEMVOX Academy - Alternative School Program