Registration Form

What is your date of birth?

Please follow the format DD/MM/Y

What is your full name?

Who is your emergency contact?

Which address is correct?

• 1080 Wellington Rd, London, ON n6E 1m2

• 1080 Wellington Rd,London,ON N6E 1M2

• 1080 wellington Rd, London, ON N6E 1M2

• 1080 Wellington Rd, London, ON N6E 1M2

Are you married?

• Yes

• No

Do you have children?

• Yes

• No

Do you like to learn English online?

• Yes

• No