PERSONAL INFORMATION
  Student's First Name:       
Male
  Student's Last Name:     
Female
  Home Address:                  
  City:                                      Province:
  Postal Code:                      Email Address:
  Home Phone:                  Cell Phone:
  Parent(s)/Guardian Names (if applicable):          
  Emergency Contact Name:    Emergency Contact No:  
   
EDUCATIONAL INFORMATION (if applicable)
  Grade/Level (as of September 1st, 2006):      School Attending:     
   
ENROLLMENT INFORMATION
  10-12 yrs                        13-15 yrs                        16-17 yrs                        Adult                
 
ADDITIONAL INFORMATION
  Notes:
 
  How did you hear about us?     
 
PAYMENT INFORMATION - Full payment due with registration
  Visa:                Mastercard:                Cheque: (enclosed)                Debit/Cash:                
  * Fees must be paid in full by Visa, Mastercard, Cheque, Cash, Bank Draft, or Debit card and should be payable to THE BLUECHIP CONNECTION LTD. - Cash or Debit must be paid in person at the office. All fees must be paid in full two weeks prior to program start date. YOU WILL NOT BE REGISTERED FOR THE CLASS IF PAYMENT HAS NOT BEEN RECEIVED.
** Credit card payments must be phoned in, Debit or Cash payments must be made in person, Cheques can be mailed with registration form.
 
AUTHORIZATION - Please read carefully
  Parents, guardians and students agree to abide by all rules, regulations, financial policies and procedures and standards of conduct. I further acknowledge that refunds and transfers are not permitted.
Anyone withdrawing from the program IN THE TWO WEEKS PRIOR TO CLASSES STARTING WILL FORFEIT THE REGISTRATION FEE IN FULL. Once the pre-interview has taken place, a cancellation fee of $200 will be charged FOR WITHDRAWING FROM THE PROGRAM. Days missed cannot be refunded.