Contact

1. Personal Information

Full Name: Preferred Name: Date of Birth: Gender: Address: City: Postal Code: Phone Number:

Applying for Grade/Level: Learning Level: Previous School Name:

Current IEP: No Yes Speech OT

Other Child Specific Info:

Guardian Name: Relationship: Contact Number: Email: Guardian Name: Relationship: Contact Number: Email:

Does the student have any medical conditions? Yes No

If yes, list: Allergies (if any):

How did you learn about The Hive? What are you looking for in a specialized private school?

I, the undersigned, declare that all the information provided above is true and accurate to the best of my knowledge.

Signature of Parent/Guardian: Date: