42285 Yarrow Central Rd. Chilliwack, BC V2R 5E3

Please complete this form and our co-ordinator will contact you.

Student's Name
Birth Date
Last Grade Completed
Any Medical Concerns (Allergies)
Attend Church School, and Where?
Any Brothers & Sisters

Parent's Name
Email
Address
Phone
Work Phone
Emergency Phone
Health Care Phone
Parent's Church
Comments
reCaptcha