CICS

Program Registration

Location:

Login:

Or just fill in the form below:

Personal Information

*First Name

*Last Name

*Age

*Gender

* Date of Birth (YYYY-MM-DD):

Please fill in at least one of the two phone number input boxes

*Phone:

*Mobile:

*Email

*Address

*Postal Code

*City

*Province

Currently in ESL?

Immigration Status and Information

Immigration Status

Country of Origin:

Classes

Emergency Contact #1:

*Emergency Name

*Emergency Phone

*Emergency Relationship

Emergency Contact #2:

*Emergency Name

*Emergency Phone

*Emergency Relationship

Parent/Guardians Authorization

By registering for this program, I agree to the following:

* I am responsible for the my personal safety and my personal belongings. I will not hold CICS liable for any personal injury and/or loss or damage to my personal property through participation in the program.

I understand that pictures and videos of me may be taken during the program, and I give permission for the pictures and videos to be used by CICS for promotional purposes through its media outlets.

I would like CICS to keep me updated on future programs and services by email, and I understand I can unsubscribe at any time.

* Security Number:

Type the numbers you see in the block

Register Fees	Annual Course Fee
	Level 1-6			Level 7-9
	1^st subject	2^nd subject	3^rd subject	1^st subject	2^nd subject	3^rd subject
	$160.00	$155.00	$150.00	$170.00	$165.00	$160.00

Level	1	2	3	4	5	6	7	8	9	Fee
9:45 - 11am	M1	M2	M3	M4	M5	M6	E7	F8	F9
11 - 12:15am	E1	E2	E3	E4	E5	F6	F7	E8	M9
12:15 - 1:30pm	-	-	-	F4	F5	E6	M7	M8	E9