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 ($1330.00.00/monthly includes early drop off if needed. 7:30am - 8:50am drop off, 9am - 3:30pm instructional day)FOOD PROGRAM FULL TIME ($325/monthly includes 2 healthy snacks and a healthy lunch)PART - TIME 2 DAY (only available for JK/SK students) ($920.00/monthly)PART - TIME 3 DAY (only available for JK-SK students) ($1170.00/monthly)PART - TIME HALF - DAY (only available for JK - SK students) (morning 9:00am - 12:00pm, or afternoon 12:30pm - 3:15pm) ($45/day)FOOD PROGRAM FOR PART - TIME STUDENTS ($132/ monthly for 2 DAY program)FOOD PROGRAM FOR PART - TIME STUDENTS ($198/monthly for 3 DAY program)EXTENDED CARE ($220/monthly, 3:30PM - 4:45pm)
There is a one-time, non-refundable registration fee of $350. 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 $350 registration fee to halton@evergreenlearning.ca

All pre-paid fees are non-refundable.
Should be Empty:

EVERGREEN ACADEMY

Student Information:

Emergency Contact Information