Student Registration Form
Personal Information
Family Name:
Given Name:
Gender:
Select Gender
Male
Female
Birth Date (mm/dd/yyyy):
Email:
Phone:
Address (Home/Apt # Street):
City:
Province:
Postal Code:
Country:
Emergency Contact Information
Emergency Contact Name:
Relationship:
Emergency Contact Address:
Emergency Phone:
Program Information
Preferred Start Date (mm/dd/yyyy):
Additional Information
Country of Origin:
Select Country
Canada
China
Brazil
America
Bhutan
Australia
India
Japan
Mexico
Russia
South Africa
United Kingdom
France
Germany
Italy
South Korea
Spain
Sweden
Turkey
Other
Please specify:
Passport Number:
Immigration Category:
Open Work Permit
Closed Work Permit
Permanent Resident
Office of Immigration Client # (if issued):
Upload Work Permit (PDF, JPG, PNG):
Student Contract
I agree that I must maintain an 80 percent attendance rate. I understand that if my attendance drops below 80 percent I will be at risk to lose my seat in class. These are not LINC classes. I acknowledge and accept that during the course of my study or during activity programs, I may be photographed, videotaped, or audio taped and I hereby grant SACC unrestricted and non-expiring permission and all rights to use or license such media for any advertising or promotional purposes that SACC may deem appropriate, without any compensation whatsoever. I hereby authorize any doctor, EMS or medical facility to provide treatment to me if I am injured or ill whether or not I am able to provide consent.
I agree to the student contract
Signature:
Date:
Submit
