Form2go

Form2go

SECTION ONE

CANADIAN RESIDENT REGISTRATION FORM
Course Name/Code you wish to register with COHS:*

Full Name*

Prefix

First Name

Middle Name

Last Name

Date of Birth*
Sex:*
Male
Female
Home/Cell Phone*
### ### ####
Email Address*

eg. xyz@domain.com

Home Address*

Address Line 1
Address Line 2
City	State
Zip Code	Country

SECTION TWO

NON RESIDENT OF CANADA ONLY
Are you a Canadian Citizen?*
Yes
No

Full Name

Prefix

First Name

Middle Name

Last Name

Date of Birth*
Home/Cell Phone*
### ### ####
Email Address*

eg. xyz@domain.com

Home Address

Address Line 1
Address Line 2
City	State
Zip Code	Country

Note:

We only offer courses in English at this time. No English as a Second Language or English Learning Development is offered.
SECTION THREE

EDUCATION INFORMATION
Are you currently attending high school?*
Yes
No
Current or last high school attended:*
Month/Year of last attendance*
High School Address:*
School Board Address*
High School Phone Number*
### ### ####
OEM# (If presently attending school in Ontario)*
Do you have any Special Learning Needs?*
Yes
No
If 'Yes'

COHS may not be able to serve your needs at this time. Our resources are not in place for Special Learning Needs.
Instructions

1. Click the submit button to complete form.

Security Code*