experience the difference2

Enrolment Request Form

STUDENT INFORMATION


Name:
Gender:
Siblings currently attending Durham Christian:
Home Phone:
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Student Cell Phone:
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Student E-mail:
Date of Birth (d/m/yr):
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Current Grade Level:
T-Shirt Size (Adult Sizes)
Preferred Name: *
Address:


PARENTAL INFORMATION


Father's Name:
Father's Home Phone:
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Father's Cell Phone:
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Father's Employer:
Father's Work Phone:
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Father's E-mail:
Church Name & Denomination :
Father's Address:

Mother's Name:
Mother's Home Phone:
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Mother's Cell Phone:
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Mother's Employer:
Mother's Work Phone:
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Mother's E-mail:
Church Name & Denomination:
* If parents are separated or divorced, please indicate custody arrangements here:
Mother's Address:


EDUCATION INFORMATION


Previous School Attended: *
School Phone:
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Principal:


EMERGENCY INFORMATION


Emergency Contact:
Phone:
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Family Doctor:
Doctor's Phone:
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Health Card Number: *
Are there any health concerns of which school staff should be aware? (Significant Allergies, Learning Needs, Medical Conditions):
Other Information (Special circumstances, guardian arrangements etc...) :
Does your child have an IEP?(Individual Education Plan): *

PRIVACY PROTECTION: Personal information collected by Durham Christian High School will be used for the explicit business functions and administration of the school and not shared without written consent of the member/parent. Reasonable effort will be made to ensure that personal information is accurate and up-to-date and personal information will not be stored any longer than necessary.


CONFIRMATION *
Date: *
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Verification:
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