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Metropolitan College 2013 Registration Form
Submit Online or Print and Fax: 416-849-7942
Student Information
First Name
*
Last Name:
*
Sex:
*
Male
Female
Birthdate: (mm/dd/yy)
*
Nationality:
*
Passport Number:
*
Address: (Home/Appt#, Street):
*
City:
*
Province/State:
Country:
*
Postal Code:
Telephone:
*
Fax:
Email:
Emergency Contact Name:
*
Emergency Phone:
*
Study Information: SECTION A
Start Date: (mm/dd/yy)
Weeks of Study:
*
Select Study Program:
*
Full Time $220/week
Full Time Intensive $295.00/week
Program Fee - SECTION A Total $:
Accomodation Information - OPTIONAL - SECTION B
Start Date: (mm/dd/yy)
Do you require placement? + $150 fee:
Homestay with 3 meals per day $200/week
Weeks of Accomodation:
Any dietary restriction?
YES
NO
If YES, specify:
Any medical condition, we should be aware of?
YES
NO
If YES, specify:
Do you smoke?
Yes
No
(most families do not allow smoking indoors)
Any allergies?
YES
NO
If YES, please specify:
Do you have medical insurance?
If YES, specify company:
Interests and Comments:
Accomodation - Section B Total $:
Airport Services (Optional) - SECTION C
Do you require Airport Pick up?
YES
NO
Airline:
Flight Number:
Select Airport Service
Pick up ONLY $100.00
Pick up and RETURN $150.00
Arrival Date (mm/dd/yy)
Arrival Time:
Arriving From:
Airport Fee - Section C Total $:
Medical Insurance (Mandatory) - Section D
Do you require Medical Insurance through school?
NO, I have already Medical insurance arrangements through another provider.
Start date: (mm/dd/yy)
*
End date (mm/dd/yy)
*
Total Number of days:
*
Med. Insurance Fee: $2/day X Number of Days
Insurance - Section D Total $:
FEE CALCULATOR
Program Fee: (Section A Total)
Program Registration Fee: $100
Homestay Fee (if applicable) SECTION B
Airport Fee (if applicable) Section C Total
Medical Insurance Fee (if applicable) Section D Total
Grand Total $:
STUDENT CONTRACT
I declare that the information I have given is correct and accurate. I have read and understand all term and Conditions
I agree:
Date (mm/dd/yy)
*
Students name submitting the form.
*