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Student Registration Form

NRHS Student Registration

Welcome to our Student Registration Form. Please take a minute to complete all relevant fields in the form before submitting. Be sure to notify Student Services at NRHS (396-2750) that you have completed this form.

Thank you,
NRHS Student Services

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*1.	Please enter your 10 digit Nova Scotia student number. This can be obtained from your previous school. (If you do not have a student number, use your home phone number without spaces or hyphens.)

*2.	Student's last name?

*3.	Student's first name?

*4.	Student's middle name(s)?

*5.	Student's preferred name? (This is the name commonly used when referring to this student.)

*6.	What is the civic address where the student resides? (for example: 1234 South Street)

*7.	What is the name of the town/village where the student resides?

*8.	In what province will the student reside? (for example: NS)

9.	What is the mailing address for this student? ( for example: PO Box 123)

10.	What is the mailing address town/village for this student?

11.	What is the mailing address province for this student? (for example: NS)

12.	What is the mailing address postal code for this student?

*13.

What is the student's date of birth?

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	Day	Month	Year(YYYY)
Birthdate:

*14.

What is the student's gender?

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	Male
	Female

15.	What is the student's home phone number?

16.	With whom does the student reside? (for example: parents; mother; father)

17.	If there are any custody arrangements, or others matters of a legal nature that apply to this student, please state them below.

18.	If you wish, please indicate any ethnic categories that may apply to this student.

19.

Which grade will the student be entering when they attend NRHS?

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	9
	10
	11
	12
	RG

20.	Please state any medical alerts that may apply to this student.

21.	Please elaborate on any medical alerts listed above.

22.	What is the first name of the First Contact person for this student?

23.	What is the last name for the First Contact person for this student?

24.	What is the First Contact's civic address?

25.	What is the First Contact's town/village?

26.	In which province does the First Contact reside? (for example: NS)

27.	What is the First Contact's postal code?

28.	What is the First Contact's work phone number?

29.	What is the First Contact's home phone number?

30.	What is the First Contact's cell phone number?

31.	What is the First Contact's email address?

32.	What is the First Contact's relation to the student?(for example: Mother, Father)

33.	What is the first name of the Second Contact person for this student?

34.	What is the last name of the Second Contact person for this student?

35.	What is the Second Contact's civic address?

36.	What is the Second Contact's town/village?

37.	In which province does the second contact reside?

38.	What is the Second Contact's work phone number?

39.	What is the Second Contact's home phone number?

40.	What is the Second Contact's cell phone number?

41.	What is the Second Contact's email address?

42.	What is the Second Contact's postal code?

43.	What is the Second Contact's relation to the student?

44.	What is the first name of the Emergency Contact person for this student?

45.	What is the last name of the Emergency Contact person for this student?

46.	What is the Emergency Contact's civic address?

47.	What is the Emergency Contact's town/village?

48.	In which province does the Emergency Contact reside

49.	What is the Emergency Contact's postal code?

50.	What is the Emergency Contact's work phone number?

51.	What is the Emergency Contact's home phone number?

52.	What is the Emergency Contact's cell phone number?

53.	What is the Emergency Contact's email address?

54.	What is the Emergency Contact's relation to the student?

55.	What is the name of the student's doctor?

56.	What is the phone number for the student's doctor?

57.	What is the name of the last school this student attended?

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