Let Your Light Shine Form

School Registration
Let Your Light Shine Electrical Academy

Plair Contruction
Additional documents for registration

Bring this registration form and the following documentation to the school office.

• Original Indentication Card

Payments Options

$1000 Full Payment includes All materials and tools needed.

$500 Deposit due time of registration $100 after 2 weeks on a weekly basis.

Courses includes Apprentice Licensing!
Student Information
Name

First NameLast Name
Birth Date

MonthDayYear
Ethnicity
Gender
Email Address
Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Grade
Semester
Have you previously applied to or attended this school?
If yes, what year?
Current Residence Information
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Home Phone Number

Area CodePhone Number
Primary Residence Information (if different from above)
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Parent/Guardian Residence Information (if different from above)
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Emergency Contact 1
Name

First NameLast Name
Phone Number

Area CodePhone Number
Email
example@example.com
Emergency Contact 2
Name

First NameLast Name
Phone Number

Area CodePhone Number
Email
example@example.com
Physician and Medical Information
Name

First NameLast Name
Phone Number

Area CodePhone Number
Email
example@example.com
Preferred Hospital
Insurance/Health Coverage (Company)
Please list any of the following: Current medications, Medication allergies, Food allergies, Chronic health concerns.

Previous School
School Name
City
State
Date Started

MonthDayYear
Date Ended

MonthDayYear
Notes
Please inform the office of any other vital information you think they may need to know in the event of an emergency. Thank you.
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