Student's First Name*

Student's Middle Name

Student's Last Name*

Select Gender*Select GenderMaleFemale

Age as of Sept 1*

Present School*

Address*

City*

Postal Code*

Present Grade*

EdG Student Number

Parents/Guardians Name*

Home Phone*

Work Phone*

Cell Phone*

Primary Email ID*

Secondary Email ID

Emergency Contact Name*

Emergency Ph.No*

Sibling Name if Enrolled in the Class

Sibling Student

Returning Student (If there is term gap or more in the registration, then the student is to be re-registered.)*Select Yes or NoYesNo

Select Grade Level*Select Grade LevelLevel Pre-KLevel KLevel 1Level 2Level 3Level 4Level 5Level 6Level 7Level 8Level 9Level 10Level 11Level 12

Select mode for Enrollment*Select ModeIN CENTER (AT OUR CENTER)VIRTUAL (VIA VIDEO CONF)SELF (SELF STUDY)NOT SURE

Notes