Name of student Date of birth Grade Home address Name of School Is the school Fresh Immersion ? Yes No Does the student have learning disabilities: If Yes please explain Mothers full name Phone number Email Occupation Fathers full name Phone number Email Occupation Is the student registering to: Please select On-site Programs Online Programs On-site & Online Programs Student Email * Password * * I HEREBY CERTIFY THAT THE ABOVE INFORMATION IS CORRECT AND I GIVE PERMISSION TO STUDENTSCHOLARS ACADEMIC, ART & MUSIC CENTRE INC. TO USE MY INFORMATION STATED ABOVE FOR CENTRE RELATED WORK. Submit
