Regina Public Schools' Registration Form - Caluculus 30

Student Number: School Division: Birthdate: Day   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   Month 1 2 3 4 5 6 7 8 9 10 11 12   Year 1970 1971 1972 1973 1974 1975 1976 1977 1978 1979 1980 1981 1982 1983 1984 1985 1986 1987 1988 1989 1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 Gender: Male Female

Student Type: School Aged Under the age of 18 years or 16 years of age or older registered with a school and / or a school division and / or Indian Band Adult 16 years of age or older and not registered with a school and / or a school division and / or an Indian Band

Surname: First Name: Second Name: Maiden Name:

Home Address: City or Town: Province: SK BC AB MB ON QB NB PE NS NF NW YK NU Postal Code:

Home Phone: Business Phone: Fax: Email Address:

Exam Date: January June

Student's School Name or Adult's Received School Name: School Number:

School Contact Person: Position:

School Address: City or Town: Province: SK BC AB MB ON QB NB PE NS NF NW YK NU Postal Code:

School Phone Number: School Fax Number: