ASK Online Canada

Student Registration Form

Mr.□ Miss□ Last Name: __________________________ Given Name(s): ________________________________

Date of Birth: Day __________ Month ___________ Year ___________ Age: ___________

Address: ____________________________________________________________________________________

City /Country / Postal Code: ______________________________________________________________________

Telephone: __________________ Student Email: __________________________________________________

Country of Citizenship: ____________________________ Copy of Source Document attached: _______________

Emergency Contact: _______________________Relationship: ___________ Telephone: ____________________

Mother’s Name: _________________________________ Email: ___________________________________

Father’s Name: __________________________________ Email: ____________________________________

Study Goals: __________________________________________________________________________________

Courses for Start date: Anticipated Mid-term Mark Application Fees Paid
Enrolment End Date: Final Fee

Please read and check off the boxes to acknowledge your agreement:
• I understand that I must pay all fees in full and submit last two years of school reports prior to being enrolled
in any ASK Online Canada online courses.
• I understand that the fees are non-refundable.
•Upon successful completion of the course/s, applicable report cards, credits and diploma will be issued.
• I acknowledge that I will complete the work on my own, independently and will not plagiarize, copy or use the
work of others and represent it as my own.
• I understand and accept that if I have been caught cheating, plagiarizing or using the work of others and
representing it as my own, I will not receive credit for the course and I will not receive a refund of tuitions.

____________________________________ __________________________________
Student signature Date

___________________________________________ __________________________________
Parent signature (for students 18 years and younger) Date