First Name (as in the Passport): *
Last Name (as in the Passport): *
M/F: * Male Female
Birth Date: M/D/Y * 1 2 3 4 5 6 7 8 9 10 11 12 / 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 / 2014 2013 2012 2011 2010 2009 2008 2007 2006 2005 2004 2003 2002 2001 2000 1999 1998 1997 1996 1995
Citizenship: *
Main Phone *
Other Phone
Street Address: *
Address Line 2:
City: *
E-mail Address: *
Province * Alberta British Columbia Manitoba New Brunswick Newfoundland and Labrador Nova Scotia Ontario Prince Edward Island Quebec Saskatchewan --Canadian Territories-- Northwest Territories Nunavut Yukon
Postal Code: *
Present school: *
Grade: *
School board *
Rooming preference Name 1:
Rooming preference Name 2:
* Required