STUDENT REGISTRATION FORM

If you have any questions, please feel free to contact us at bpolan@seiq.com.  Or call us at 1-514-217-7369.

PERSONAL INFORMATION   (PLEASE PRINT IN ENGLISH)
First Name: Last Name:
Date of Birth: (Day/Month/Year) Country of Citizenship:
City of Birth: Gender: Male   Female
Age:
Address:
City: Phone Number:
Province: Fax Number:
Country: Email:
Postal Code:
EMERGENCY CONTACT #1 EMERGENCY CONTACT #2
Name: Name:
Phone Number: Phone Number:
Relationship: Relationship:
STATUS IN CANADA
International Student?: Yes  No Study Permit?: Yes  No  N/A
Level of English? Beginner  High Beginner  Intermediate  High Intermediate
Level of French? Beginner  High Beginner  Intermediate  High Intermediate
When do you arrive in Montreal?  
STUDY PROGRAM
How long do you wish to attend high school in Montreal: 1 academic year (10 months)
 5 months 3 months
What grade have you completed by time of registration:
What grade do you wish to attend when you arrive in Montreal area:
Do you need assistance in finding accomodation in Montreal: Yes  No
Do you wish to use SEIQ's pick up airport service : Yes  No
(Note: some groups have this fee as part of their registration package – discuss with your representative.)

By submitting this form, and checking the box below,
I confirm that I have read and accepted the General Terms and Conditions, the Cancellation and Refund Policy, and the release agreement.